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Influenza vaccination may limit the impact of influenza in the community. The aim of this study was to assess the effectiveness of influenza vaccination in preventing hospitalisation in individuals aged ≥ 65 years in Spain. A multicentre case–control study was conducted in 20 Spanish hospitals during 2013/14 and 2014/15. Patients aged ≥ 65 years who were hospitalised with laboratory-confirmed influenza were matched with controls according to sex, age and date of hospitalisation. Adjusted vaccine effectiveness (VE) was calculated by multivariate conditional logistic regression. A total of 728 cases and 1,826 matched controls were included in the study. Overall VE was 36% (95% confidence interval (CI): 22–47). VE was 51% (95% CI: 15–71) in patients without high-risk medical conditions and 30% (95% CI: 14–44) in patients with them. VE was 39% (95% CI: 20–53) in patients aged 65–79 years and 34% (95% CI: 11–51) in patients aged ≥ 80 years, and was greater against the influenza A(H1N1)pdm09 subtype than the A(H3N2) subtype. Influenza vaccination was effective in preventing hospitalisations of elderly individuals.


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  1. Treanor JJ. Influenza Viruses Including Avian Influenza. In: Bennet JE, Dolin R, Blaser MJ, editors. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia: Elsevier; 2015. p. 2000-29.
  2. World Health Organization (WHO). Influenza (Seasonal): Fact sheet. Geneva: WHO; Nov 2016. [Accessed 2 Aug 2016]. Available from: http://www.who.int/mediacentre/factsheets/fs211/en/
  3. Foppa IM, Cheng PY, Reynolds SB, Shay DK, Carias C, Bresee JS, et al. Deaths averted by influenza vaccination in the U.S. during the seasons 2005/06 through 2013/14. Vaccine. 2015;33(26):3003-9.  https://doi.org/10.1016/j.vaccine.2015.02.042  PMID: 25812842 
  4. Bonmarin I, Belchior E, Lévy-Bruhl D. Impact of influenza vaccination on mortality in the French elderly population during the 2000-2009 period. Vaccine. 2015;33(9):1099-101.  https://doi.org/10.1016/j.vaccine.2015.01.023  PMID: 25604800 
  5. Lang PO, Mendes A, Socquet J, Assir N, Govind S, Aspinall R. Effectiveness of influenza vaccine in aging and older adults: comprehensive analysis of the evidence. Clin Interv Aging. 2012;7:55-64.  https://doi.org/10.2147/CIA.S25215  PMID: 22393283 
  6. Beyer WE, McElhaney J, Smith DJ, Monto AS, Nguyen-Van-Tam JS, Osterhaus AD. Cochrane re-arranged: support for policies to vaccinate elderly people against influenza. Vaccine. 2013;31(50):6030-3.  https://doi.org/10.1016/j.vaccine.2013.09.063  PMID: 24095882 
  7. Sistema de Vigilancia de la Gripe en España. Informe de Vigilancia de la Gripe en España. Temporada 2013-2014 (Desde la semana 40/2013 hasta la semana 20/2014). [Influenza surveillance report in Spain. Season 2013/2014. (From week 40/2013 until week 20/2014)]. Madrid: Instituto de Salud Carlos III. [Accessed 10 Nov 2016]. Spanish. Available from: http://www.isciii.es/ISCIII/es/contenidos/fd-servicios-cientifico-tecnicos/fd-vigilancias-alertas/fd-enfermedades/Informe_Vigilancia_GRIPE_2013-2014_v19122014.pdf
  8. Sistema de Vigilancia de la Gripe en España. Informe de Vigilancia de la Gripe en España. Temporada 2014-2015 (Desde la semana 40/2014 hasta la semana 20/2015). [Influenza surveillance report in Spain. Season 2014/2015. (From week 40/2014 until week 20/2015)]. Madrid: Instituto de Salud Carlos III. [Accessed 22 Aug 2016]. Spanish. Available from: http://www.isciii.es/ISCIII/es/contenidos/fd-servicios-cientifico-tecnicos/fd-vigilancias-alertas/fd-enfermedades/pdf_2015/Informe_Vigilancia_GRIPE_2014-2015_vf_29092015.pdf
  9. Fiore AE, Bridges CB, Katz JM, Cox NJ. Inactivated influenza vaccines. In: Plotkin SA, Orenstein WA, Offit PA, editors. Vaccines. 6th ed. Philadelphia: Elsevier; 2013. p. 257-93.
  10. R Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing. [Accessed 1 Aug 2017]. Available from: https://www.R-project.org
  11. Remschmidt C, Rieck T, Bödeker B, Wichmann O. Application of the screening method to monitor influenza vaccine effectiveness among the elderly in Germany. BMC Infect Dis. 2015;15(1):137.  https://doi.org/10.1186/s12879-015-0882-3  PMID: 25887460 
  12. Talbot HK, Griffin MR, Chen Q, Zhu Y, Williams JV, Edwards KM. Effectiveness of seasonal vaccine in preventing confirmed influenza-associated hospitalizations in community dwelling older adults. J Infect Dis. 2011;203(4):500-8.  https://doi.org/10.1093/infdis/jiq076  PMID: 21220776 
  13. Minodier L, Blanchon T, Souty C, Turbelin C, Leccia F, Varesi L, et al. Influenza vaccine effectiveness: best practice and current limitations of the screening method and their implications for the clinic. Expert Rev Vaccines. 2014;13(8):1039-48.  https://doi.org/10.1586/14760584.2014.930666  PMID: 24946796 
  14. Puig-Barberà 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  PMID: 25742432 
  15. Pierse N, Kelly H, Thompson MG, Bissielo A, Radke S, Huang QS, et al. Influenza vaccine effectiveness for hospital and community patients using control groups with and without non-influenza respiratory viruses detected, Auckland, New Zealand 2014. Vaccine. 2016;34(4):503-9.  https://doi.org/10.1016/j.vaccine.2015.11.073  PMID: 26685091 
  16. 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  PMID: 27369320 
  17. Qin Y, Zhang Y, Wu P, Feng S, Zheng J, Yang P, et al. Influenza vaccine effectiveness in preventing hospitalization among Beijing residents in China, 2013-15. Vaccine. 2016;34(20):2329-33.  https://doi.org/10.1016/j.vaccine.2016.03.068  PMID: 27026147 
  18. Turner N, Pierse N, Huang QS, Radke S, Bissielo A, Thompson MG, et al. Interim estimates of the effectiveness of seasonal trivalent inactivated influenza vaccine in preventing influenza hospitalisations and primary care visits in Auckland, New Zealand, in 2014. Euro Surveill. 2014;19(42):20934.  https://doi.org/10.2807/1560-7917.ES2014.19.42.20934  PMID: 25358042 
  19. McLean HQ, Thompson MG, Sundaram ME, Kieke BA, Gaglani M, Murthy K, et al. Influenza vaccine effectiveness in the United States during 2012-2013: variable protection by age and virus type. J Infect Dis. 2015;211(10):1529-40.  https://doi.org/10.1093/infdis/jiu647  PMID: 25406334 
  20. McElhaney JE, Zhou X, Talbot HK, Soethout E, Bleackley RC, Granville DJ, et al. The unmet need in the elderly: how immunosenescence, CMV infection, co-morbidities and frailty are a challenge for the development of more effective influenza vaccines. Vaccine. 2012;30(12):2060-7.  https://doi.org/10.1016/j.vaccine.2012.01.015  PMID: 22289511 
  21. Spadea A, Unim B, Colamesta V, Meneghini A, D’Amici AM, Giudiceandrea B, et al. Is the adjuvanted influenza vaccine more effective than the trivalent inactivated vaccine in the elderly population? Results of a case-control study. Vaccine. 2014;32(41):5290-4.  https://doi.org/10.1016/j.vaccine.2014.07.077  PMID: 25087677 
  22. 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  PMID: 27025838 
  23. Treanor JJ. Influenza Viruses. In: Kaslow RA, Stanberry LR, Le Duc JW, editors. Viral Infections of Humans. 5th ed. New York: Springer; 2014. p. 455-78.
  24. High K. Immunizations in older adults. Clin Geriatr Med. 2007;23(3):669-85, viii-ix.  https://doi.org/10.1016/j.cger.2007.03.007  PMID: 17631240 
  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. PMID: 25590680 
  26. Castilla J, Martínez-Baz I, Navascués A, Fernandez-Alonso M, Reina G, Guevara M, et al. Vaccine effectiveness in preventing laboratory-confirmed influenza in Navarre, Spain: 2013/14 mid-season analysis. Euro Surveill. 2014;19(6):20700.  https://doi.org/10.2807/1560-7917.ES2014.19.6.20700  PMID: 24556347 
  27. World Health Organization. Recommended composition of influenza virus vaccines for use in the 2015–2016 northern hemisphere influenza season. Wkly Epidemiol Rec. 2015;90(11):97-108. PMID: 25771542 
  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  PMID: 26854911 
  29. Neuzil KM. How can we solve the enigma of influenza vaccine-induced protection? J Infect Dis. 2015;211(10):1517-8.  https://doi.org/10.1093/infdis/jiu651  PMID: 25416811 
  30. Castilla J, Navascués A, Fernández-Alonso M, Reina G, Albéniz E, Pozo F, et al. Effects of previous episodes of influenza and vaccination in preventing laboratory-confirmed influenza in Navarre, Spain, 2013/14 season. Euro Surveill. 2016;20(22):30243.  https://doi.org/10.2807/1560-7917.ES.2016.21.22.30243  PMID: 27277013 

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