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Systems for register-based monitoring of vaccine effectiveness (VE) against laboratory-confirmed influenza (LCI) in real time were set up in Stockholm County, Sweden, and Finland, before start of the 2016/17 influenza season, using population-based cohort studies. Both in Stockholm and Finland, an early epidemic of influenza A(H3N2) peaked in week 52, 2016. Already during weeks 48 to 50, analyses of influenza VE in persons 65 years and above showed moderately good estimates of around 50%, then rapidly declined by week 2, 2017 to 28% and 32% in Stockholm and Finland, respectively. The sensitivity analyses, where time since vaccination was taken into account, could not demonstrate a clear decline, neither by calendar week nor by time since vaccination. Most (68%) of the samples collected from vaccinated patients belonged to the 3C.2a1 subclade with the additional amino acid substitution T135K in haemagglutinin (64%) or to subclade 3C.2a with the additional haemagglutinin substitutions T131K and R142K (36%). The proportion of samples containing these alterations increased during the studied period. These substitutions may be responsible for viral antigenic change and part of the observed VE drop. Another possible cause is poor vaccine immunogenicity in older persons. Improved influenza vaccines are needed, especially for the elderly.


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  1. Leval A, Hergens MP, Persson K, Örtqvist Å. Real-time real-world analysis of seasonal influenza vaccine effectiveness: method development and assessment of a population-based cohort in Stockholm County, Sweden, seasons 2011/12 to 2014/15. Euro Surveill. 2016;21(43):30381.  https://doi.org/10.2807/1560-7917.ES.2016.21.43.30381  PMID: 27813473 
  2. Nohynek H, Baum U, Syrjänen R, Ikonen N, Sundman J, Jokinen J. Effectiveness of the live attenuated and the inactivated influenza vaccine in two-year-olds - a nationwide cohort study Finland, influenza season 2015/16. Euro Surveill. 2016;21(38):30346.  https://doi.org/10.2807/1560-7917.ES.2016.21.38.30346  PMID: 27684447 
  3. Carlsson AC, Wändell P, Ösby U, Zarrinkoub R, Wettermark B, Ljunggren G. High prevalence of diagnosis of diabetes, depression, anxiety, hypertension, asthma and COPD in the total population of Stockholm, Sweden - a challenge for public health. BMC Public Health. 2013;13(1):670.  https://doi.org/10.1186/1471-2458-13-670  PMID: 23866784 
  4. Rolfhamre P, Jansson A, Arneborn M, Ekdahl K. SmiNet-2: Description of an internet-based surveillance system for communicable diseases in Sweden. Euro Surveill. 2006;11(5):103-7. PMID: 16757847 
  5. Szegö J. Bebyggelsens mosaic. [The mosaic of the settlement]. Regionplanekontoret, Stockholm report no 7:2009. Stockholm: Regionplanekontoret; 2009. Swedish. Available from: http://www.rufs.se/publikationer/20092/20097-bebyggelsens-mosaik/Error! Hyperlink reference not valid.
  6. Ministry of Social Affairs and Health. Communicable Disease Act No. 583/1986. Helsinki: Ministry of Social Affairs and Health; 25 July 1986. Available from: http://www.finlex.fi/fi/laki/kaannokset/1986/en19860583.pdf
  7. European Centre for Disease Prevention and Control (ECDC). Influenza virus characterisation, summary Europe, September 2016. Stockholm: ECDC; 2016. Available from: http://ecdc.europa.eu/en/publications/Publications/influenza-virus-characterisation-september-2016.pdf
  8. Kissling E, Nunes B, Robertson C, Valenciano M, Reuss A, Larrauri A, et al. I-MOVE multicentre case-control study 2010/11 to 2014/15: Is there within-season waning of influenza type/subtype vaccine effectiveness with increasing time since vaccination? Euro Surveill. 2016;21(16):30201.  https://doi.org/10.2807/1560-7917.ES.2016.21.16.30201  PMID: 27124420 
  9. Leung VK, Cowling BJ, Feng S, Sullivan SG. Concordance of interim and final estimates of influenza vaccine effectiveness: a systematic review. Euro Surveill. 2016;21(16):30202.  https://doi.org/10.2807/1560-7917.ES.2016.21.16.30202  PMID: 27124573 
  10. 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 
  11. Skowronski DM, Janjua NZ, De Serres G, Sabaiduc S, Eshaghi A, Dickinson JA, et al. Low 2012-13 influenza vaccine effectiveness associated with mutation in the egg-adapted H3N2 vaccine strain not antigenic drift in circulating viruses. PLoS One. 2014;9(3):e92153.  https://doi.org/10.1371/journal.pone.0092153  PMID: 24667168 
  12. Ferdinands JM, Fry AM, Reynolds S, Petrie J, Flannery B, Jackson ML, et al. Intraseason waning of influenza vaccine protection: Evidence from the US Influenza Vaccine Effectiveness Network, 2011-12 through 2014-15. Clin Infect Dis. 2016;ciw816.  https://doi.org/10.1093/cid/ciw816  PMID: 28039340 
  13. Belongia EA, Sundaram ME, McClure DL, Meece JK, Ferdinands J, VanWormer JJ. Waning vaccine protection against influenza A (H3N2) illness in children and older adults during a single season. Vaccine. 2015;33(1):246-51.  https://doi.org/10.1016/j.vaccine.2014.06.052  PMID: 24962752 
  14. Long J, Bushnell RV, Tobin JK, Pan K, Deem MW, Nara PL, et al. Evolution of H3N2 influenza virus in a guinea pig model. PLoS One. 2011;6(7):e20130.  https://doi.org/10.1371/journal.pone.0020130  PMID: 21799726 
  15. Ekiert DC, Kashyap AK, Steel J, Rubrum A, Bhabha G, Khayat R, et al. Cross-neutralization of influenza A viruses mediated by a single antibody loop. Nature. 2012;489(7417):526-32.  https://doi.org/10.1038/nature11414  PMID: 22982990 
  16. Skowronski DM, Chambers C, Sabaiduc S, Dickinson JA, Winter AL, De Serres G, et al. Interim estimates of 2016/17 vaccine effectiveness against influenza A(H3N2), Canada, January 2017. Euro Surveill. 2017;22(6):30460.  https://doi.org/10.2807/1560-7917.ES.2017.22.6.30460  PMID: 28205503 
  17. 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 
  18. DiazGranados CA, Robertson CA, Talbot HK, Landolfi V, Dunning AJ, Greenberg DP. Prevention of serious events in adults 65 years of age or older: A comparison between high-dose and standard-dose inactivated influenza vaccines. Vaccine. 2015;33(38):4988-93.  https://doi.org/10.1016/j.vaccine.2015.07.006  PMID: 26212007 
  19. DiazGranados CA, Dunning AJ, Kimmel M, Kirby D, Treanor J, Collins A, et al. Efficacy of high-dose versus standard-dose influenza vaccine in older adults. N Engl J Med. 2014;371(7):635-45.  https://doi.org/10.1056/NEJMoa1315727  PMID: 25119609 
  20. Frey SE, Reyes MR, Reynales H, Bermal NN, Nicolay U, Narasimhan V, et al. Comparison of the safety and immunogenicity of an MF59®-adjuvanted with a non-adjuvanted seasonal influenza vaccine in elderly subjects. Vaccine. 2014;32(39):5027-34.  https://doi.org/10.1016/j.vaccine.2014.07.013  PMID: 25045825 

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