Research article Open Access
Like 0



Influenza vaccine is recommended for the entire population in Israel. We assessed influenza vaccine effectiveness (VE) for the 2014/15 and 2015/16 seasons in Israel, for the first time. Combined nose and throat swab specimens were collected from patients with influenza-like illness (ILI) presenting to sentinel primary care clinics and tested for influenza virus by RT-PCR. VE of the trivalent inactivated vaccine (TIV) was assessed using test-negative case–control design. During the 2014/15 season 1,142 samples were collected; 327 (28.6%) were positive for influenza, 83.8% A(H3N2), 5.8% A(H1N1)pdm09, 9.2% B and 1.2% A un-subtyped. Adjusted VE against all influenza viruses for this influenza season was −4.8% (95% confidence interval (CI): −54.8 to 29.0) and against influenza A(H3N2), it was −15.8% (95% CI: −72.8 to 22.4). For the 2015/16 season, 1,919 samples were collected; 853 (44.4%) were positive for influenza, 43.5% A(H1N1)pdm09, 57% B, 0.7% A(H3N2) and 11 samples positive for both A(H1N1)pdm09 and B. Adjusted VE against all influenza viruses for this influenza season was 8.8% (95% CI: −25.1 to 33.5), against influenza A(H1N1)pdm09, it was 32.3% (95% CI: (−4.3 to 56.1) and against influenza B, it was −2.2% (95% CI: (−47.0 to 29.0). Using samples from patients with ILI visiting sentinel clinics in Israel, we demonstrated the feasibility of influenza VE estimation in Israel.


Article metrics loading...

Loading full text...

Full text loading...



  1. World Health Organization (WHO). Influenza (Seasonal) - Fact sheet No 211. Geneva: WHO; Jan 2018. [Accessed 28 Jan 2018]. Available from: http://www.who.int/mediacentre/factsheets/fs211/en/
  2. Jimenez-Jorge S, de Mateo S, Delgado-Sanz C, Pozo F, Casas I, Garcia-Cenoz M, et al. Estimating influenza vaccine effectiveness in Spain using sentinel surveillance data. Euro Surveill. 2015;20(28):21187.  https://doi.org/10.2807/1560-7917.ES2015.20.28.21187 
  3. Radin JM, Hawksworth AW, Myers CA, Ricketts MN, Hansen EA, Brice GT. Influenza vaccine effectiveness: Maintained protection throughout the duration of influenza seasons 2010-2011 through 2013-2014. Vaccine. 2016;34(33):3907-12.  https://doi.org/10.1016/j.vaccine.2016.05.034 
  4. Israel Center for Disease Control (ICDC). Surveillance of influenza-like illness in Israel. Weekly update report for Week 15, ending 16-Apr-16. Ramat Gan: ICDC; 2016. Available from: http://www.health.gov.il/PublicationsFiles/flu16042016e.pdf
  5. Al-Abdallat M, Dawson P, Haddadin AJ, El-Shoubary W, Dueger E, Al-Sanouri T, et al. Influenza hospitalization epidemiology from a severe acute respiratory infection surveillance system in Jordan, January 2008-February 2014. Influenza Other Respi Viruses. 2016;10(2):91-7.  https://doi.org/10.1111/irv.12354 
  6. Refaey S, Amin M, Labib M, Kandeel A. Influenza virus positivity and circulating subtypes among cases of influenza-like illness and severe acute respiratory infection, Egypt, 2012-2015. East Mediterr Health J. 2016;22(7):527-36.  https://doi.org/10.26719/2016.22.7.523 
  7. Israel Ministry of Health. [Vaccination Guidelines - Influenza]. Jerusalem: Israel Ministry of Health; 2015. Hebrew. Available from: http://www.health.gov.il/UnitsOffice/HD/PH/epidemiology/td/docs/360_Influenza.pdf
  8. Israel Center for Disease Control (ICDC). Summary Report - The 2014/2015 influenza season. Ramat Gan: ICDC; Sep 2015. https://www.health.gov.il/PublicationsFiles/flu2014-2015_EN.pdf
  9. Israel Center for Disease Control (ICDC). Summary Report - The 2015/2016 influenza season. Ramat Gan: ICDC; Jul 2016. Available from: www.health.gov.il/PublicationsFiles/flu2015-2016e.pdf
  10. Belongia EA, Simpson MD, King JP, Sundaram ME, Kelley NS, Osterholm MT, et al. Variable influenza vaccine effectiveness by subtype: a systematic review and meta-analysis of test-negative design studies. Lancet Infect Dis. 2016;16(8):942-51.  https://doi.org/10.1016/S1473-3099(16)00129-8 
  11. Centers for Disease Control and Prevention (CDC). Influenza Specimen Collection. Atlanta: CDC. [Accessed 17 Oct 2017]. Available from: https://www.cdc.gov/flu/pdf/freeresources/healthcare/flu-specimen-collection-guide.pdf
  12. Bromberg M, Kaufman Z, Mandelboim M, Sefty H, Shalev V, Marom R, et al. Clinical and virological surveillance of influenza in Israel--implementation during pandemic influenza. Harefuah. 2009;148(9):577-82, 659.
  13. Hindiyeh M, Goulding C, Morgan H, Kenyon B, Langer J, Fox L, et al. Evaluation of BioStar FLU OIA assay for rapid detection of influenza A and B viruses in respiratory specimens. J Clin Virol. 2000;17(2):119-26.  https://doi.org/10.1016/S1386-6532(00)00081-0 
  14. Hindiyeh M, Levy V, Azar R, Varsano N, Regev L, Shalev Y, et al. Evaluation of a multiplex real-time reverse transcriptase PCR assay for detection and differentiation of influenza viruses A and B during the 2001-2002 influenza season in Israel. J Clin Microbiol. 2005;43(2):589-95.  https://doi.org/10.1128/JCM.43.2.589-595.2005 
  15. Hindiyeh M, Ram D, Mandelboim M, Meningher T, Hirsh S, Robinov J, et al. Rapid detection of influenza A pandemic (H1N1) 2009 virus neuraminidase resistance mutation H275Y by real-time reverse transcriptase PCR. J Clin Microbiol. 2010;48(5):1884-7.  https://doi.org/10.1128/JCM.02540-09 
  16. Itoh Y, Shinya K, Kiso M, Watanabe T, Sakoda Y, Hatta M, et al. In vitro and in vivo characterization of new swine-origin H1N1 influenza viruses. Nature. 2009;460(7258):1021-5.  https://doi.org/10.1038/nature08260 
  17. World Health Organization (WHO). Sequencing primers and protocol. Geneva: WHO; 12 May 2009. [Accessed 26 Jan 2018]. Available from: http://www.who.int/csr/resources/publications/swineflu/sequencing_primers/en/
  18. Pebody R, Warburton F, Andrews N, Ellis J, von Wissmann B, Robertson C, et al. Effectiveness of seasonal influenza vaccine in preventing laboratory-confirmed influenza in primary care in the United Kingdom: 2014/15 end of season results. Euro Surveill. 2015;20(36):30013.  https://doi.org/10.2807/1560-7917.ES.2015.20.36.30013 
  19. Valenciano M, Kissling E, Reuss A, Jiménez-Jorge S, Horváth JK, Donnell JM, et al. The European I-MOVE Multicentre 2013-2014 Case-Control Study. Homogeneous moderate influenza vaccine effectiveness against A(H1N1)pdm09 and heterogenous results by country against A(H3N2). Vaccine. 2015;33(24):2813-22.  https://doi.org/10.1016/j.vaccine.2015.04.012 
  20. Israel Center for Disease Control (ICDC). Surveillance of influenza-like illness in Israel. Weekly update report for Week 16, ending 18-Apr-15. Ramat Gan: ICDC; 2015. Available from: http://www.health.gov.il/PublicationsFiles/flu18042015e.pdf
  21. Mandelboim M, Glatman-Freedman A, Drori Y, Sherbany H, Pando R, Sefty H, et al. Ineffectiveness of the 2014-2015 H3N2 influenza vaccine. Oncotarget. 2016;7(2):1185-92.  https://doi.org/10.18632/oncotarget.6746 
  22. Pando R, Drori Y, Friedman N, Glatman-Freedman A, Sefty H, Shohat T, et al. Influenza A(H1N1)pdm 2009 and influenza B virus co-infection in hospitalized and non-hospitalized patients during the 2015-2016 epidemic season in Israel. J Clin Virol. 2017;88:12-6.  https://doi.org/10.1016/j.jcv.2017.01.002 
  23. Pebody RG, Warburton F, Ellis J, Andrews N, Thompson C, von Wissmann B, et al. Low effectiveness of seasonal influenza vaccine in preventing laboratory-confirmed influenza in primary care in the United Kingdom: 2014/15 mid-season results. Euro Surveill. 2015;20(5):21025.  https://doi.org/10.2807/1560-7917.ES2015.20.5.21025 
  24. Skowronski DM, Chambers C, Sabaiduc S, De Serres G, Winter AL, Dickinson JA, et al. A Perfect Storm: Impact of Genomic Variation and Serial Vaccination on Low Influenza Vaccine Effectiveness During the 2014-2015 Season. Clin Infect Dis. 2016;63(1):21-32.  https://doi.org/10.1093/cid/ciw176 
  25. Flannery B, Clippard J, Zimmerman RK, Nowalk MP, Jackson ML, Jackson LA, et al. Early estimates of seasonal influenza vaccine effectiveness - United States, January 2015. MMWR Morb Mortal Wkly Rep. 2015;64(1):10-5.
  26. Flannery B, Zimmerman RK, Gubareva LV, Garten RJ, Chung JR, Nowalk MP, et al. Enhanced Genetic Characterization of Influenza A(H3N2) Viruses and Vaccine Effectiveness by Genetic Group, 2014-2015. J Infect Dis. 2016;214(7):1010-9.  https://doi.org/10.1093/infdis/jiw181 
  27. Zimmerman RK, Nowalk MP, Chung J, Jackson ML, Jackson LA, Petrie JG, et al. 2014-2015 Influenza Vaccine Effectiveness in the United States by Vaccine Type. Clin Infect Dis. 2016;63(12):1564-73.  https://doi.org/10.1093/cid/ciw635 
  28. Castilla J, Navascués A, Fernández-Alonso M, Reina G, Pozo F, Casado I, et al. Effectiveness of subunit influenza vaccination in the 2014-2015 season and residual effect of split vaccination in previous seasons. Vaccine. 2016;34(11):1350-7.  https://doi.org/10.1016/j.vaccine.2016.01.054 
  29. Redlberger-Fritz M, Kundi M, Popow-Kraupp T. Detailed Report on 2014/15 Influenza Virus Characteristics, and Estimates on Influenza Virus Vaccine Effectiveness from Austria’s Sentinel Physician Surveillance Network. PLoS One. 2016;11(3):e0149916.  https://doi.org/10.1371/journal.pone.0149916 
  30. Petrie JG, Ohmit SE, Cheng CK, Martin ET, Malosh RE, Lauring AS, et al. Influenza Vaccine Effectiveness Against Antigenically Drifted Influenza Higher Than Expected in Hospitalized Adults: 2014-2015. Clin Infect Dis. 2016;63(8):1017-25.  https://doi.org/10.1093/cid/ciw432 
  31. Puig-Barbera J, Mira-Iglesias A, Tortajada-Girbes M, Lopez-Labrador FX, Belenguer-Varea A, Carballido-Fernandez M, et al. Effectiveness of influenza vaccination programme in preventing hospital admissions, Valencia, 2014/15 early results. Euro Surveill. 2015;20(8):21044.  https://doi.org/10.2807/1560-7917.ES2015.20.8.21044 
  32. Centers for Disease Control and Prevention (CDC). Influenza vaccine effectiveness, including LAIV vs IIV in children and adolescents, US Flu VE Network, 2015-2016. Atlanta: CDC; 22 Jun 2016. [Accessed 26 Jan 2018]. Available from: http://www.nitag-resource.org/uploads/media/default/0001/03/31080dbc0778d8ef07c95caee0dd35cb452ada4d.pdf</eref>
  33. Chambers C, Skowronski DM, Sabaiduc S, Winter AL, Dickinson JA, De Serres G, et al. Interim estimates of 2015/16 vaccine effectiveness against influenza A(H1N1)pdm09, Canada, February 2016. Euro Surveill. 2016;21(11):30168. https://doi.org/10.2807/1560-7917.ES.2016.21.11.30168 PMID:27020673 
  34. Kissling E, Valenciano M. Early influenza vaccine effectiveness results 2015-16: I-MOVE multicentre case-control study. Euro Surveill. 2016;21(6):30134. https://doi.org/10.2807/1560-7917.ES.2016.21.6.30134 PMID:26898240 
  35. Pebody R, Warburton F, Ellis J, Andrews N, Potts A, Cottrell S, et al. Effectiveness of seasonal influenza vaccine for adults and children in preventing laboratory-confirmed influenza in primary care in the United Kingdom: 2015/16 end-of-season results. Euro Surveill. 2016;21(38):30348. https://doi.org/10.2807/1560-7917.ES.2016.21.38.30348 PMID:27684603 
  36. European Centre for Disease Prevention and Control (ECDC). Surveillance Report. Influenza characterization report, summary Europe, March 2016. Stockholm: ECDC; 2016. Available from: http://ecdc.europa.eu/en/publications/Publications/influenza-virus-characterisation-march-2016.pdf
  37. Sharabi S, Drori Y, Micheli M, Friedman N, Orzitzer S, Bassal R, et al. Epidemiological and Virological Characterization of Influenza B Virus Infections. PLoS One. 2016;11(8):e0161195.  https://doi.org/10.1371/journal.pone.0161195 
  38. Davlin SL, Blanton L, Kniss K, Mustaquim D, Smith S, Kramer N, et al. Influenza Activity - United States, 2015-16 Season and Composition of the 2016-17 Influenza Vaccine. MMWR Morb Mortal Wkly Rep. 2016;65(22):567-75. https://doi.org/10.15585/mmwr.mm6522a3 PMID:27281364 
  39. Saito N, Komori K, Suzuki M, Morimoto K, Kishikawa T, Yasaka T, et al. Negative impact of prior influenza vaccination on current influenza vaccination among people infected and not infected in prior season: A test-negative case-control study in Japan. Vaccine. 2017;35(4):687-93.  https://doi.org/10.1016/j.vaccine.2016.11.024 

Data & Media loading...

Comment has been disabled for this content
Submit comment
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error