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The impact of repeated vaccination using 10-year vaccination history on protection against influenza in older adults: a test-negative design study across the 2010/11 to 2015/16 influenza seasons in Ontario, Canada.
Euro Surveill. 2020 01; 25(1)ES

Abstract

IntroductionAnnual influenza vaccination is recommended for older adults, but evidence regarding the impact of repeated vaccination has been inconclusive.AimWe investigated vaccine effectiveness (VE) against laboratory-confirmed influenza and the impact of repeated vaccination over 10 previous seasons on current season VE among older adults.MethodsWe conducted an observational test-negative study in community-dwelling adults aged > 65 years in Ontario, Canada for the 2010/11 to 2015/16 seasons by linking laboratory and health administrative data. We estimated VE using multivariable logistic regression. We assessed the impact of repeated vaccination by stratifying by previous vaccination history.ResultsWe included 58,304 testing episodes for respiratory viruses, with 11,496 (20%) testing positive for influenza and 31,004 (53%) vaccinated. Adjusted VE against laboratory-confirmed influenza for the six seasons combined was 21% (95% confidence interval (CI): 18 to 24%). Patients who were vaccinated in the current season, but had received no vaccinations in the previous 10 seasons, had higher current season VE (34%; 95%CI: 9 to 52%) than patients who had received 1-3 (26%; 95%CI: 13 to 37%), 4-6 (24%; 95%CI: 15 to 33%), 7-8 (13%; 95%CI: 2 to 22%), or 9-10 (7%; 95%CI: -4 to 16%) vaccinations (trend test p = 0.001). All estimates were higher after correcting for misclassification of current season vaccination status. For patients who were not vaccinated in the current season, residual protection rose significantly with increasing numbers of vaccinations received previously.ConclusionsAlthough VE appeared to decrease with increasing numbers of previous vaccinations, current season vaccination likely provides some protection against influenza regardless of the number of vaccinations received over the previous 10 influenza seasons.

Authors+Show Affiliations

Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Public Health Ontario, Toronto, Ontario, Canada. Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada. Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada. ICES, Toronto, Ontario, Canada.ICES, Toronto, Ontario, Canada.ICES, Toronto, Ontario, Canada.Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Public Health Ontario, Toronto, Ontario, Canada. ICES, Toronto, Ontario, Canada.Hospital for Sick Children, Toronto, Ontario, Canada. University Health Network, Toronto, Ontario, Canada.ICES, Toronto, Ontario, Canada.Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada. Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada. Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. ICES, Toronto, Ontario, Canada.Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada. Hospital for Sick Children, Toronto, Ontario, Canada. Public Health Ontario, Toronto, Ontario, Canada.Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada. Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.North York General Hospital, Toronto, Ontario, Canada.Sinai Health System, Toronto, Ontario, Canada. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada. Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.William Osler Health System, Brampton, Ontario, Canada.Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada. Hospital for Sick Children, Toronto, Ontario, Canada.Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Public Health Ontario, Toronto, Ontario, Canada. ICES, Toronto, Ontario, Canada.Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Public Health Ontario, Toronto, Ontario, Canada. ICES, Toronto, Ontario, Canada.Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.McMaster University, Hamilton, Ontario, Canada.Newfoundland & Labrador Public Health Laboratory, St. John's, Newfoundland and Labrador, Canada. London Health Sciences Centre, London, Ontario, Canada.CIRN is acknowledged at the end of the article.

Pub Type(s)

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

Language

eng

PubMed ID

31937397

Citation

Kwong, Jeffrey C., et al. "The Impact of Repeated Vaccination Using 10-year Vaccination History On Protection Against Influenza in Older Adults: a Test-negative Design Study Across the 2010/11 to 2015/16 Influenza Seasons in Ontario, Canada." Euro Surveillance : Bulletin Europeen Sur Les Maladies Transmissibles = European Communicable Disease Bulletin, vol. 25, no. 1, 2020.
Kwong JC, Chung H, Jung JK, et al. The impact of repeated vaccination using 10-year vaccination history on protection against influenza in older adults: a test-negative design study across the 2010/11 to 2015/16 influenza seasons in Ontario, Canada. Euro Surveill. 2020;25(1).
Kwong, J. C., Chung, H., Jung, J. K., Buchan, S. A., Campigotto, A., Campitelli, M. A., Crowcroft, N. S., Gubbay, J. B., Karnauchow, T., Katz, K., McGeer, A. J., McNally, J. D., Richardson, D. C., Richardson, S. E., Rosella, L. C., Schwartz, K. L., Simor, A., Smieja, M., Zahariadis, G., & On Behalf Of The Canadian Immunization Research Network Cirn Investigators, . (2020). The impact of repeated vaccination using 10-year vaccination history on protection against influenza in older adults: a test-negative design study across the 2010/11 to 2015/16 influenza seasons in Ontario, Canada. Euro Surveillance : Bulletin Europeen Sur Les Maladies Transmissibles = European Communicable Disease Bulletin, 25(1). https://doi.org/10.2807/1560-7917.ES.2020.25.1.1900245
Kwong JC, et al. The Impact of Repeated Vaccination Using 10-year Vaccination History On Protection Against Influenza in Older Adults: a Test-negative Design Study Across the 2010/11 to 2015/16 Influenza Seasons in Ontario, Canada. Euro Surveill. 2020;25(1) PubMed PMID: 31937397.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The impact of repeated vaccination using 10-year vaccination history on protection against influenza in older adults: a test-negative design study across the 2010/11 to 2015/16 influenza seasons in Ontario, Canada. AU - Kwong,Jeffrey C, AU - Chung,Hannah, AU - Jung,James Kh, AU - Buchan,Sarah A, AU - Campigotto,Aaron, AU - Campitelli,Michael A, AU - Crowcroft,Natasha S, AU - Gubbay,Jonathan B, AU - Karnauchow,Timothy, AU - Katz,Kevin, AU - McGeer,Allison J, AU - McNally,J Dayre, AU - Richardson,David C, AU - Richardson,Susan E, AU - Rosella,Laura C, AU - Schwartz,Kevin L, AU - Simor,Andrew, AU - Smieja,Marek, AU - Zahariadis,George, AU - On Behalf Of The Canadian Immunization Research Network Cirn Investigators,, PY - 2020/1/16/entrez PY - 2020/1/16/pubmed PY - 2020/8/28/medline KW - Influenza vaccine KW - older adults KW - repeated vaccination KW - vaccine effectiveness JF - Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin JO - Euro Surveill VL - 25 IS - 1 N2 - IntroductionAnnual influenza vaccination is recommended for older adults, but evidence regarding the impact of repeated vaccination has been inconclusive.AimWe investigated vaccine effectiveness (VE) against laboratory-confirmed influenza and the impact of repeated vaccination over 10 previous seasons on current season VE among older adults.MethodsWe conducted an observational test-negative study in community-dwelling adults aged > 65 years in Ontario, Canada for the 2010/11 to 2015/16 seasons by linking laboratory and health administrative data. We estimated VE using multivariable logistic regression. We assessed the impact of repeated vaccination by stratifying by previous vaccination history.ResultsWe included 58,304 testing episodes for respiratory viruses, with 11,496 (20%) testing positive for influenza and 31,004 (53%) vaccinated. Adjusted VE against laboratory-confirmed influenza for the six seasons combined was 21% (95% confidence interval (CI): 18 to 24%). Patients who were vaccinated in the current season, but had received no vaccinations in the previous 10 seasons, had higher current season VE (34%; 95%CI: 9 to 52%) than patients who had received 1-3 (26%; 95%CI: 13 to 37%), 4-6 (24%; 95%CI: 15 to 33%), 7-8 (13%; 95%CI: 2 to 22%), or 9-10 (7%; 95%CI: -4 to 16%) vaccinations (trend test p = 0.001). All estimates were higher after correcting for misclassification of current season vaccination status. For patients who were not vaccinated in the current season, residual protection rose significantly with increasing numbers of vaccinations received previously.ConclusionsAlthough VE appeared to decrease with increasing numbers of previous vaccinations, current season vaccination likely provides some protection against influenza regardless of the number of vaccinations received over the previous 10 influenza seasons. SN - 1560-7917 UR - https://www.unboundmedicine.com/medline/citation/31937397/The_impact_of_repeated_vaccination_using_10_year_vaccination_history_on_protection_against_influenza_in_older_adults:_a_test_negative_design_study_across_the_2010/11_to_2015/16_influenza_seasons_in_Ontario_Canada_ L2 - http://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.1.1900245 DB - PRIME DP - Unbound Medicine ER -