1887
Research Open Access
Like 0

Abstract

Introduction

Annual influenza vaccination is recommended for older adults, but evidence regarding the impact of repeated vaccination has been inconclusive.

Aim

We 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.

Methods

We 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.

Results

We 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.

Conclusions

Although 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.

Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2020.25.1.1900245
2020-01-09
2024-03-29
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2020.25.1.1900245
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/25/1/eurosurv-25-1-4.html?itemId=/content/10.2807/1560-7917.ES.2020.25.1.1900245&mimeType=html&fmt=ahah

References

  1. Grohskopf LA, Sokolow LZ, Broder KR, Walter EB, Fry AM, Jernigan DB. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices-United States, 2018-19 Influenza Season. MMWR Recomm Rep. 2018;67(3):1-20.  https://doi.org/10.15585/mmwr.rr6703a1  PMID: 30141464 
  2. 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  PMID: 27061888 
  3. Rondy M, El Omeiri N, Thompson MG, Levêque A, Moren A, Sullivan SG. Effectiveness of influenza vaccines in preventing severe influenza illness among adults: A systematic review and meta-analysis of test-negative design case-control studies. J Infect. 2017;75(5):381-94.  https://doi.org/10.1016/j.jinf.2017.09.010  PMID: 28935236 
  4. Darvishian M, Bijlsma MJ, Hak E, van den Heuvel ER. Effectiveness of seasonal influenza vaccine in community-dwelling elderly people: a meta-analysis of test-negative design case-control studies. Lancet Infect Dis. 2014;14(12):1228-39.  https://doi.org/10.1016/S1473-3099(14)70960-0  PMID: 25455990 
  5. Hoskins TW, Davies JR, Smith AJ, Miller CL, Allchin A. Assessment of inactivated influenza-A vaccine after three outbreaks of influenza A at Christ’s Hospital. Lancet. 1979;313(8106):33-5.  https://doi.org/10.1016/S0140-6736(79)90468-9  PMID: 83475 
  6. Keitel WA, Cate TR, Couch RB, Huggins LL, Hess KR. Efficacy of repeated annual immunization with inactivated influenza virus vaccines over a five year period. Vaccine. 1997;15(10):1114-22.  https://doi.org/10.1016/S0264-410X(97)00003-0  PMID: 9269055 
  7. Smith DJ, Forrest S, Ackley DH, Perelson AS. Variable efficacy of repeated annual influenza vaccination. Proc Natl Acad Sci USA. 1999;96(24):14001-6.  https://doi.org/10.1073/pnas.96.24.14001  PMID: 10570188 
  8. Cheng AC, Macartney KK, Waterer GW, Kotsimbos T, Kelly PM, Blyth CC, et al. Influenza Complications Alert Network (FluCAN) Investigators. Repeated Vaccination Does Not Appear to Impact Upon Influenza Vaccine Effectiveness Against Hospitalization With Confirmed Influenza. Clin Infect Dis. 2017;64(11):1564-72.  https://doi.org/10.1093/cid/cix209  PMID: 28329167 
  9. Young B, Sadarangani S, Jiang L, Wilder-Smith A, Chen MI. Duration of Influenza Vaccine Effectiveness: A Systematic Review, Meta-analysis, and Meta-regression of Test-Negative Design Case-Control Studies. J Infect Dis. 2018;217(5):731-41.  https://doi.org/10.1093/infdis/jix632  PMID: 29220496 
  10. Russell K, Chung JR, Monto AS, Martin ET, Belongia EA, McLean HQ, et al. Influenza vaccine effectiveness in older adults compared with younger adults over five seasons. Vaccine. 2018;36(10):1272-8.  https://doi.org/10.1016/j.vaccine.2018.01.045  PMID: 29402578 
  11. Valenciano M, Kissling E, Larrauri A, Nunes B, Pitigoi D, O’Donnell J, et al. . Exploring the effect of previous inactivated influenza vaccination on seasonal influenza vaccine effectiveness against medically attended influenza: Results of the European I-MOVE multicentre test-negative case-control study, 2011/2012-2016/2017. Influenza Other Respir Viruses. 2018;12(5):567-81.  https://doi.org/10.1111/irv.12562  PMID: 29659149 
  12. Domínguez A, Soldevila N, Toledo D, Godoy P, Espejo E, Fernandez MA, et al. The Working Group Of The Project Pi/. The effectiveness of influenza vaccination in preventing hospitalisations of elderly individuals in two influenza seasons: a multicentre case-control study, Spain, 2013/14 and 2014/15. Euro Surveill. 2017;22(34):1-8.  https://doi.org/10.2807/1560-7917.ES.2017.22.34.30602  PMID: 28857047 
  13. Ohmit SE, Thompson MG, Petrie JG, Thaker SN, Jackson ML, Belongia EA, et al. Influenza vaccine effectiveness in the 2011-2012 season: protection against each circulating virus and the effect of prior vaccination on estimates. Clin Infect Dis. 2014;58(3):319-27.  https://doi.org/10.1093/cid/cit736  PMID: 24235265 
  14. Belongia EA, Skowronski DM, McLean HQ, Chambers C, Sundaram ME, De Serres G. Repeated annual influenza vaccination and vaccine effectiveness: review of evidence. Expert Rev Vaccines. 2017;16(7):723-36.  https://doi.org/10.1080/14760584.2017.1334554  PMID: 28562111 
  15. Bartoszko JJ, McNamara IF, Aras OAZ, Hylton DA, Zhang YB, Malhotra D, et al. Does consecutive influenza vaccination reduce protection against influenza: A systematic review and meta-analysis. Vaccine. 2018;36(24):3434-44.  https://doi.org/10.1016/j.vaccine.2018.04.049  PMID: 29724509 
  16. Ramsay LC, Buchan SA, Stirling RG, Cowling BJ, Feng S, Kwong JC, et al. The impact of repeated vaccination on influenza vaccine effectiveness: a systematic review and meta-analysis. BMC Med. 2019;17(1):9.  https://doi.org/10.1186/s12916-018-1239-8  PMID: 30626399 
  17. McLean HQ, Thompson MG, Sundaram ME, Meece JK, McClure DL, Friedrich TC, et al. Impact of repeated vaccination on vaccine effectiveness against influenza A(H3N2) and B during 8 seasons. Clin Infect Dis. 2014;59(10):1375-85.  https://doi.org/10.1093/cid/ciu680  PMID: 25270645 
  18. Örtqvist Å, Brytting M, Leval A, Hergens MP. Impact of repeated influenza vaccinations in persons over 65 years of age: A large population-based cohort study of severe influenza over six consecutive seasons, 2011/12-2016/17. Vaccine. 2018;36(37):5556-64.  https://doi.org/10.1016/j.vaccine.2018.07.052  PMID: 30076104 
  19. Kwong JC, Buchan SA, Chung H, Campitelli MA, Schwartz KL, Crowcroft NS, et al. Can routinely collected laboratory and health administrative data be used to assess influenza vaccine effectiveness? Assessing the validity of the Flu and Other Respiratory Viruses Research (FOREVER) Cohort. Vaccine. 2019;37(31):4392-400.  https://doi.org/10.1016/j.vaccine.2019.06.011  PMID: 31221563 
  20. Jackson ML, Nelson JC. The test-negative design for estimating influenza vaccine effectiveness. Vaccine. 2013;31(17):2165-8.  https://doi.org/10.1016/j.vaccine.2013.02.053  PMID: 23499601 
  21. Fox MP, Lash TL, Greenland S. A method to automate probabilistic sensitivity analyses of misclassified binary variables. Int J Epidemiol. 2005;34(6):1370-6.  https://doi.org/10.1093/ije/dyi184  PMID: 16172102 
  22. Schwartz KL, Jembere N, Campitelli MA, Buchan SA, Chung H, Kwong JC. Using physician billing claims from the Ontario Health Insurance Plan to determine individual influenza vaccination status: an updated validation study. CMAJ Open. 2016;4(3):E463-70.  https://doi.org/10.9778/cmajo.20160009  PMID: 27730110 
  23. The Cochrane Collaboration. Cochrane Handbook for Systematic Reviews of Interventions. March 2011. (Version 5.1.0). [Accessed 4 Nov 2019]. Available from: https://handbook-5-1.cochrane.org/chapter_9/9_6_4_meta_regression.htm
  24. Vittinghoff E, Glidden DV, Shiboski SC, McCulloch CE. Regression methods in biostatistics: Linear, logistic, survival, and repeated measures models. 2nd ed. New York: Springer; 2012.
  25. Skowronski DM, Chambers C, De Serres G, Sabaiduc S, Winter AL, Dickinson JA, et al. Serial vaccination and the antigenic distance hypothesis: Effects on influenza vaccine effectiveness during A(H3N2) epidemics in Canada, 2010-2011 to 2014-2015. J Infect Dis. 2017;215(7):1059-99.  https://doi.org/10.1093/infdis/jix074  PMID: 28180277 
  26. Thompson MG, Naleway A, Fry AM, Ball S, Spencer SM, Reynolds S, et al. Effects of Repeated Annual Inactivated Influenza Vaccination among Healthcare Personnel on Serum Hemagglutinin Inhibition Antibody Response to A/Perth/16/2009 (H3N2)-like virus during 2010-11. Vaccine. 2016;34(7):981-8.  https://doi.org/10.1016/j.vaccine.2015.10.119  PMID: 26813801 
  27. Davies JR, Grilli EA. Natural or vaccine-induced antibody as a predictor of immunity in the face of natural challenge with influenza viruses. Epidemiol Infect. 1989;102(2):325-33.  https://doi.org/10.1017/S0950268800030004  PMID: 2703026 
  28. Belongia EA, Kieke BA, Donahue JG, Greenlee RT, Balish A, Foust A, et al. Marshfield Influenza Study Group. Effectiveness of inactivated influenza vaccines varied substantially with antigenic match from the 2004-2005 season to the 2006-2007 season. J Infect Dis. 2009;199(2):159-67.  https://doi.org/10.1086/595861  PMID: 19086915 
/content/10.2807/1560-7917.ES.2020.25.1.1900245
Loading

Data & Media loading...

Supplementary data

Submit comment
Close
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