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Influenza vaccine effectiveness to prevent influenza-related hospitalizations and serious outcomes in Canadian adults over the 2011/12 through 2013/14 influenza seasons: A pooled analysis from the Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance (SOS Network).

Abstract

BACKGROUND

Ongoing assessment of influenza vaccine effectiveness (VE) is critical to inform public health policy. This study aimed to determine the VE of trivalent influenza vaccine (TIV) for preventing influenza-related hospitalizations and other serious outcomes over three consecutive influenza seasons.

METHODS

The Serious Outcomes Surveillance (SOS) Network of the Canadian Immunization Research Network (CIRN) conducted active surveillance for influenza in adults ≥16 years (y) of age during the 2011/2012, 2012/2013 and 2013/2014 seasons in hospitals across Canada. A test-negative design was employed: cases were polymerase chain reaction (PCR)-positive for influenza; controls were PCR-negative for influenza and were matched to cases by date, admission site, and age (≥65 y or <65 y). All cases and controls had demographic and clinical characteristics (including influenza immunization status) obtained from the medical record. VE was estimated as 1-OR (odds ratio) in vaccinated vs. unvaccinated patients × 100%. The primary outcome was VE of TIV for preventing laboratory-confirmed influenza-related hospitalization; secondary outcomes included VE of TIV for preventing influenza-related intensive care unit (ICU) admission/mechanical ventilation, and influenza-related death.

RESULTS

Overall, 3394 cases and 4560 controls were enrolled; 2078 (61.2%) cases and 2939 (64.5%) controls were ≥65 y. Overall matched, adjusted VE was 41.7% (95% Confidence Interval (CI): 34.4-48.3%); corresponding VE in adults ≥65 y was 39.3% (95% CI: 29.4-47.8%) and 48.0% (95% CI: 37.5-56.7%) in adults <65 y, respectively. VE for preventing influenza-related ICU admission/mechanical ventilation in all ages was 54.1% (95% CI: 39.8-65.0%); in adults ≥65 y, VE for preventing influenza-related death was 74.5% (95% CI: 44.0-88.4%).

CONCLUSIONS

While effectiveness of TIV to prevent serious outcomes varies year to year, we demonstrate a statistically significant and clinically important TIV VE for preventing hospitalization and other serious outcomes over three seasons. Public health messaging should highlight the overall benefit of influenza vaccines over time while acknowledging year to year variability. ClinicalTrials.gov Identifier: NCT01517191.

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  • Publisher Full Text
  • Authors+Show Affiliations

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    Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada.

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    Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada.

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    Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada.

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    Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada.

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    Centre Hospitalier Universitaire de Québec, Québec, Québec, Canada.

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    University of British Columbia, Vancouver, British Columbia, Canada.

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    Sanofi Pasteur, Swiftwater, PA, USA; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.

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    Business & Decision Life Sciences, Bruxelles, Belgium(2).

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    Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada.

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    Mount Sinai Hospital, Toronto, Ontario, Canada.

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    GSK, Wavre, Belgium.

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    Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada.

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    GSK, Mississauga, Ontario, Canada.

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    McMaster University, Hamilton, Ontario, Canada.

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    North York General Hospital, Toronto, Ontario, Canada.

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    St. Boniface Hospital, Winnipeg, Manitoba, Canada.

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    Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada.

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    Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada.

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    McMaster University, Hamilton, Ontario, Canada.

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    Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada.

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    The Ottawa Hospital, Ottawa, Ontario, Canada.

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    Health Sciences North Research Institute, Sudbury, Ontario, Canada.

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    Mount Sinai Hospital, Toronto, Ontario, Canada.

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    Centre Intégré Universitaire de santé et services sociaux, Quebec, Quebec, Canada.

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    Michael Garron Hospital, Toronto, Ontario, Canada.

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    William Osler Health System, Brampton, Ontario, Canada.

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    GSK, Rockville, MD, USA.

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    McGill University, Montreal, Québec, Canada.

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    GSK, King of Prussia, PA, USA.

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    University of Alberta Hospital, Edmonton, Alberta, Canada.

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    The Moncton Hospital, Moncton, New Brunswick, Canada.

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    University of British Columbia, Vancouver, British Columbia, Canada.

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    University of Alberta Hospital, Edmonton, Alberta, Canada.

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    Centre Hospitalier Universitaire de Québec, Québec, Québec, Canada.

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    Université de Sherbrooke, Sherbrooke, Québec, Canada.

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    Horizon Health, Saint John, New Brunswick, Canada.

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    Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada.

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    Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada. Electronic address: shelly.mcneil@nshealth.ca.

    Source

    Vaccine 36:16 2018 04 12 pg 2166-2175

    MeSH

    Aged
    Aged, 80 and over
    Canada
    Case-Control Studies
    Comorbidity
    Female
    History, 21st Century
    Hospitalization
    Humans
    Immunization Programs
    Influenza A virus
    Influenza Vaccines
    Influenza, Human
    Male
    Middle Aged
    Outcome Assessment (Health Care)
    Public Health Surveillance
    Risk Factors
    Seasons
    Vaccination

    Pub Type(s)

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

    Language

    eng

    PubMed ID

    29548608

    Citation

    Nichols, Michaela K., et al. "Influenza Vaccine Effectiveness to Prevent Influenza-related Hospitalizations and Serious Outcomes in Canadian Adults Over the 2011/12 Through 2013/14 Influenza Seasons: a Pooled Analysis From the Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance (SOS Network)." Vaccine, vol. 36, no. 16, 2018, pp. 2166-2175.
    Nichols MK, Andrew MK, Hatchette TF, et al. Influenza vaccine effectiveness to prevent influenza-related hospitalizations and serious outcomes in Canadian adults over the 2011/12 through 2013/14 influenza seasons: A pooled analysis from the Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance (SOS Network). Vaccine. 2018;36(16):2166-2175.
    Nichols, M. K., Andrew, M. K., Hatchette, T. F., Ambrose, A., Boivin, G., Bowie, W., ... McNeil, S. A. (2018). Influenza vaccine effectiveness to prevent influenza-related hospitalizations and serious outcomes in Canadian adults over the 2011/12 through 2013/14 influenza seasons: A pooled analysis from the Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance (SOS Network). Vaccine, 36(16), pp. 2166-2175. doi:10.1016/j.vaccine.2018.02.093.
    Nichols MK, et al. Influenza Vaccine Effectiveness to Prevent Influenza-related Hospitalizations and Serious Outcomes in Canadian Adults Over the 2011/12 Through 2013/14 Influenza Seasons: a Pooled Analysis From the Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance (SOS Network). Vaccine. 2018 04 12;36(16):2166-2175. PubMed PMID: 29548608.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Influenza vaccine effectiveness to prevent influenza-related hospitalizations and serious outcomes in Canadian adults over the 2011/12 through 2013/14 influenza seasons: A pooled analysis from the Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance (SOS Network). AU - Nichols,Michaela K, AU - Andrew,Melissa K, AU - Hatchette,Todd F, AU - Ambrose,Ardith, AU - Boivin,Guy, AU - Bowie,William, AU - Chit,Ayman, AU - Dos Santos,Gael, AU - ElSherif,May, AU - Green,Karen, AU - Haguinet,Francois, AU - Halperin,Scott A, AU - Ibarguchi,Barbara, AU - Johnstone,Jennie, AU - Katz,Kevin, AU - Lagacé-Wiens,Phillipe, AU - Langley,Joanne M, AU - LeBlanc,Jason, AU - Loeb,Mark, AU - MacKinnon-Cameron,Donna, AU - McCarthy,Anne, AU - McElhaney,Janet E, AU - McGeer,Allison, AU - Poirier,Andre, AU - Powis,Jeff, AU - Richardson,David, AU - Schuind,Anne, AU - Semret,Makeda, AU - Shinde,Vivek, AU - Smith,Stephanie, AU - Smyth,Daniel, AU - Stiver,Grant, AU - Taylor,Geoffrey, AU - Trottier,Sylvie, AU - Valiquette,Louis, AU - Webster,Duncan, AU - Ye,Lingyun, AU - McNeil,Shelly A, AU - ,, Y1 - 2018/03/13/ PY - 2017/11/14/received PY - 2018/02/21/revised PY - 2018/02/22/accepted PY - 2018/3/20/pubmed PY - 2018/9/12/medline PY - 2018/3/18/entrez KW - Effectiveness KW - Hospitalization KW - Influenza vaccine KW - Serious outcomes SP - 2166 EP - 2175 JF - Vaccine JO - Vaccine VL - 36 IS - 16 N2 - BACKGROUND: Ongoing assessment of influenza vaccine effectiveness (VE) is critical to inform public health policy. This study aimed to determine the VE of trivalent influenza vaccine (TIV) for preventing influenza-related hospitalizations and other serious outcomes over three consecutive influenza seasons. METHODS: The Serious Outcomes Surveillance (SOS) Network of the Canadian Immunization Research Network (CIRN) conducted active surveillance for influenza in adults ≥16 years (y) of age during the 2011/2012, 2012/2013 and 2013/2014 seasons in hospitals across Canada. A test-negative design was employed: cases were polymerase chain reaction (PCR)-positive for influenza; controls were PCR-negative for influenza and were matched to cases by date, admission site, and age (≥65 y or <65 y). All cases and controls had demographic and clinical characteristics (including influenza immunization status) obtained from the medical record. VE was estimated as 1-OR (odds ratio) in vaccinated vs. unvaccinated patients × 100%. The primary outcome was VE of TIV for preventing laboratory-confirmed influenza-related hospitalization; secondary outcomes included VE of TIV for preventing influenza-related intensive care unit (ICU) admission/mechanical ventilation, and influenza-related death. RESULTS: Overall, 3394 cases and 4560 controls were enrolled; 2078 (61.2%) cases and 2939 (64.5%) controls were ≥65 y. Overall matched, adjusted VE was 41.7% (95% Confidence Interval (CI): 34.4-48.3%); corresponding VE in adults ≥65 y was 39.3% (95% CI: 29.4-47.8%) and 48.0% (95% CI: 37.5-56.7%) in adults <65 y, respectively. VE for preventing influenza-related ICU admission/mechanical ventilation in all ages was 54.1% (95% CI: 39.8-65.0%); in adults ≥65 y, VE for preventing influenza-related death was 74.5% (95% CI: 44.0-88.4%). CONCLUSIONS: While effectiveness of TIV to prevent serious outcomes varies year to year, we demonstrate a statistically significant and clinically important TIV VE for preventing hospitalization and other serious outcomes over three seasons. Public health messaging should highlight the overall benefit of influenza vaccines over time while acknowledging year to year variability. ClinicalTrials.gov Identifier: NCT01517191. SN - 1873-2518 UR - https://www.unboundmedicine.com/medline/citation/29548608/Influenza_vaccine_effectiveness_to_prevent_influenza_related_hospitalizations_and_serious_outcomes_in_Canadian_adults_over_the_2011/12_through_2013/14_influenza_seasons:_A_pooled_analysis_from_the_Canadian_Immunization_Research_Network__CIRN__Serious_Outcomes_Surveillance__SOS_Network__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0264-410X(18)30292-5 DB - PRIME DP - Unbound Medicine ER -