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In 2016/17, seasonal influenza vaccine was less effective in those aged 65 years and older in the United Kingdom. We describe the uptake, influenza-associated mortality and adjusted vaccine effectiveness (aVE) in this age group over influenza seasons 2010/11–2016/17. Vaccine uptake in 2016/17 and five previous seasons were measured using a sentinel general practitioners cohort in England; the test-negative case-control design was used to estimate pooled aVE by subtype and age group against laboratory-confirmed influenza in primary care from 2010–2017. Vaccine uptake was 64% in 65–69-year-olds, 74% in 70–74-year-olds and 80% in those aged 75 and older. Overall aVE was 32.5% (95% CI: 11.6 to 48.5); aVE by sub-type was 60.8% (95% CI: 33.9 to 76.7) and 50.0% (95% CI: 21.6 to 68.1) against influenza A(H1N1)pdm09 and influenza B, respectively, but only 5.6% (95% CI: - 39.2 to 35.9) against A(H3N2). Against all laboratory-confirmed influenza aVE was 45.2% (95% CI: 25.1 to 60.0) in 65–74 year olds; - 26.2% (95% CI: - 149.3 to 36.0) in 75–84 year olds and - 3.2% (95% CI: - 237.8 to 68.5) in those aged 85 years and older. Influenza-attributable mortality was highest in seasons dominated by A(H3N2). Vaccine uptake with non-adjuvanted, normal-dose vaccines remained high, with evidence of effectiveness against influenza A(H1N1)pdm09 and B, though poor against A(H3N2), particularly in those aged 75 years and older. Forthcoming availability of newly licensed vaccines with wider use of antivirals can potentially further improve prevention and control of influenza in this group.


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  1. Joseph C, Goddard N. Influenza vaccine uptake in the elderly: results from a rapid assessment of the effectiveness of new government policy in England for the winters 2000/2001 and 2001/2002. Vaccine. 2003;21(11-12):1137-48.  https://doi.org/10.1016/S0264-410X(02)00505-4  PMID: 12559791 
  2. Nguyen-van-Tam JS, Nicholson KG. Influenza deaths in Leicestershire during the 1989-90 epidemic: implications for prevention. Epidemiol Infect. 1992;108(3):537-45.  https://doi.org/10.1017/S0950268800050032  PMID: 1601083 
  3. Fleming DM, Watson JM, Nicholas S, Smith GE, Swan AV. Study of the effectiveness of influenza vaccination in the elderly in the epidemic of 1989-90 using a general practice database. Epidemiol Infect. 1995;115(3):581-9.  https://doi.org/10.1017/S095026880005874X  PMID: 8557090 
  4. Public Health England (PHE). Seasonal influenza vaccine uptake in GP patients: winter season 2016 to 2017. Final data for 1 September 2016 to 31 January 2017. London: PHE; 2017. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/613452/Seasonal_influenza_vaccine_uptake_in_GP_patients_winter_season_2016_to_2017.pdf
  5. Hardelid P, Pebody R, Andrews N. Mortality caused by influenza and respiratory syncytial virus by age group in England and Wales 1999-2010. Influenza Other Respi Viruses. 2013;7(1):35-45.  https://doi.org/10.1111/j.1750-2659.2012.00345.x  PMID: 22405488 
  6. Pebody R, Warburton F, Ellis J, Andrews N, Potts A, Cottrell S, et al. End-of-season influenza vaccine effectiveness in adults and children, United Kingdom, 2016/17. Euro Surveill. 2017;22(44):17-00306.  https://doi.org/10.2807/1560-7917.ES.2017.22.44.17-00306  PMID: 29113630 
  7. Lang P-O, 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 
  8. Correa A, Hinton W, McGovern A, van Vlymen J, Yonova I, Jones S, et al. Royal College of General Practitioners Research and Surveillance Centre (RCGP RSC) sentinel network: a cohort profile. BMJ Open. 2016;6(4):e011092.  https://doi.org/10.1136/bmjopen-2016-011092  PMID: 27098827 
  9. Vestergaard LS, Nielsen J, Krause TG, Espenhain L, Tersago K, Bustos Sierra N, et al. Excess all-cause and influenza-attributable mortality in Europe, December 2016 to February 2017. Euro Surveill. 2017;22(14):30506.  https://doi.org/10.2807/1560-7917.ES.2017.22.14.30506  PMID: 28424146 
  10. 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  PMID: 26535911 
  11. Public Health England (PHE). Influenza: the green book, chapter 19. Influenza immunisation information including updates for public health professionals. London: PHE; 2018. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/663694/Greenbook_chapter_19_Influenza_.pdf
  12. Gunson R, Maclean A, Davies E, Bennett S, Miller R, Carman WF. Development of a multiplex real-time RT-PCR that allows universal detection of influenza A viruses and simultaneous typing of influenza A/H1N1/2009 virus. J Virol Methods. 2010;163(2):258-61.  https://doi.org/10.1016/j.jviromet.2009.10.006  PMID: 19854220 
  13. Zambon M. Laboratory Diagnosis of Influenza. In: Nicholson K, Hay A, Webster RG, editors. Textbook of Influenza. Oxford: Blackwell Science; 1998. pp. 291-313.
  14. European Centre for Disease Prevention and Control (ECDC). Technical report: Seasonal influenza vaccination in Europe, vaccination recommendations and coverage rates in the EU member states for periods 2007/08 to 2014/15. Stockholm: ECDC; 2017. Available from: https://ecdc.europa.eu/sites/portal/files/documents/influenza-vaccination-2007%E2%80%932008-to-2014%E2%80%932015.pdf
  15. 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  PMID: 26535911 
  16. Haralambieva IH, Painter SD, Kennedy RB, Ovsyannikova IG, Lambert ND, Goergen KM, et al. The impact of immunosenescence on humoral immune response variation after influenza A/H1N1 vaccination in older subjects. PLoS One. 2015;10(3):e0122282.  https://doi.org/10.1371/journal.pone.0122282  PMID: 25816015 
  17. Nicholson KG, Abrams KR, Batham S, Clark TW, Hoschler K, Lim WS, et al. A randomised, partially observer blind, multicentre, head-to-head comparison of a two-dose regimen of Baxter and GlaxoSmithKline H1N1 pandemic vaccines, administered 21 days apart. Health Technol Assess. 2010;14(55):193-334.  https://doi.org/10.3310/hta14550-04  PMID: 21208550 
  18. Hayward AC, Wang L, Goonetilleke N, Fragaszy EB, Bermingham A, Copas A, et al. Flu Watch Group. Natural T Cell-mediated Protection against Seasonal and Pandemic Influenza. Results of the Flu Watch Cohort Study. Am J Respir Crit Care Med. 2015;191(12):1422-31.  https://doi.org/10.1164/rccm.201411-1988OC  PMID: 25844934 
  19. 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 
  20. Osterholm MT, Kelley NS, Sommer A, Belongia EA. Efficacy and effectiveness of influenza vaccines: a systematic review and meta-analysis. Lancet Infect Dis. 2012;12(1):36-44.  https://doi.org/10.1016/S1473-3099(11)70295-X  PMID: 22032844 
  21. Hergens M-P, Baum U, Brytting M, Ikonen N, Haveri A, Wiman Å, et al. Mid-season real-time estimates of seasonal influenza vaccine effectiveness in persons 65 years and older in register-based surveillance, Stockholm County, Sweden, and Finland, January 2017. Euro Surveill. 2017;22(8):30469.  https://doi.org/10.2807/1560-7917.ES.2017.22.8.30469  PMID: 28251891 
  22. Sullivan Sheena G, Chilver Monique B, Carville Kylie S, Deng Y-M, Grant Kristina A. Higgins Geoff, Komadina Naomi, Leung Vivian KY, Minney-Smith Cara A, Teng Don, Tran Thomas, Stocks Nigel, Fielding James E. Low interim influenza vaccine effectiveness, Australia, 1 May to 24 September 2017. Euro Surveill. 2017;22(43):17-00707.
  23. 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 
  24. Wu NC, Zost SJ, Thompson AJ, Oyen D, Nycholat CM, McBride R, et al. A structural explanation for the low effectiveness of the seasonal influenza H3N2 vaccine. PLoS Pathog. 2017;13(10):e1006682.  https://doi.org/10.1371/journal.ppat.1006682  PMID: 29059230 
  25. Zost SJ, Parkhouse K, Gumina ME, Kim K, Diaz Perez S, Wilson PC, et al. Contemporary H3N2 influenza viruses have a glycosylation site that alters binding of antibodies elicited by egg-adapted vaccine strains. Proc Natl Acad Sci USA. 2017;114(47):12578-83.  https://doi.org/10.1073/pnas.1712377114  PMID: 29109276 
  26. Kissling E, Nunes B, Robertson C, Valenciano M, Reuss A, Larrauri A, et al. I-MOVE case–control study team. 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 
  27. Xakellis GC. Predictors of influenza immunization in persons over age 65. J Am Board Fam Pract. 2005;18(5):426-33.  https://doi.org/10.3122/jabfm.18.5.426  PMID: 16148255 
  28. Van Buynder PG, Konrad S, Van Buynder JL, Brodkin E, Krajden M, Ramler G, et al. The comparative effectiveness of adjuvanted and unadjuvanted trivalent inactivated influenza vaccine (TIV) in the elderly. Vaccine. 2013;31(51):6122-8.  https://doi.org/10.1016/j.vaccine.2013.07.059  PMID: 23933368 
  29. 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 
  30. Domnich A, Arata L, Amicizia D, Puig-Barberà J, Gasparini R, Panatto D. Effectiveness of MF59-adjuvanted seasonal influenza vaccine in the elderly: A systematic review and meta-analysis. Vaccine. 2017;35(4):513-20.  https://doi.org/10.1016/j.vaccine.2016.12.011  PMID: 28024956 
  31. Shay DK, Chillarige Y, Kelman J, Forshee RA, Foppa IM, Wernecke M, et al. Comparative Effectiveness of High-Dose Versus Standard-Dose Influenza Vaccines Among US Medicare Beneficiaries in Preventing Postinfluenza Deaths During 2012-2013 and 2013-2014. J Infect Dis. 2017;215(4):510-7.  https://doi.org/10.1093/infdis/jiw641  PMID: 28329311 
  32. Wilkinson K, Wei Y, Szwajcer A, Rabbani R, Zarychanski R, Abou-Setta AM, et al. Efficacy and safety of high-dose influenza vaccine in elderly adults: A systematic review and meta-analysis. Vaccine. 2017;35(21):2775-80.  https://doi.org/10.1016/j.vaccine.2017.03.092  PMID: 28431815 
  33. Dunkle LM, Izikson R, Patriarca P, Goldenthal KL, Muse D, Callahan J, et al. PSC12 Study Team. Efficacy of Recombinant Influenza Vaccine in Adults 50 Years of Age or Older. N Engl J Med. 2017;376(25):2427-36.  https://doi.org/10.1056/NEJMoa1608862  PMID: 28636855 
  34. Hodgson D, Baguelin M, van Leeuwen E, Panovska-Griffiths J, Ramsay M, Pebody R, et al. Effect of mass paediatric influenza vaccination on existing influenza vaccination programmes in England and Wales: a modelling and cost-effectiveness analysis. Lancet Public Health. 2017;2(2):e74-81.  https://doi.org/10.1016/S2468-2667(16)30044-5  PMID: 28299371 
  35. Pebody RG, Green HK, Andrews N, Boddington NL, Zhao H, Yonova I, et al. Uptake and impact of vaccinating school age children against influenza during a season with circulation of drifted influenza A and B strains, England, 2014/15. Euro Surveill. 2015;20(39):30029.  https://doi.org/10.2807/1560-7917.ES.2015.20.39.30029  PMID: 26537222 
  36. Hardelid P, Rait G, Gilbert R, Petersen I. Prescribing of neuraminidase inhibitors for influenza in UK primary care since the 2009 pandemic. Epidemiol Infect. 2016;144(4):772-6.  https://doi.org/10.1017/S095026881500206X  PMID: 26364671 
  37. Talbot HK, Nian H, Chen Q, Zhu Y, Edwards KM, Griffin MR. Evaluating the case-positive, control test-negative study design for influenza vaccine effectiveness for the frailty bias. Vaccine. 2016;34(15):1806-9.  https://doi.org/10.1016/j.vaccine.2016.02.037  PMID: 26930368 
  38. Rondy M, Gherasim A, Casado I, Launay O, Rizzo C, Pitigoi D, et al. I-MOVE+ hospital working group. Low 2016/17 season vaccine effectiveness against hospitalised influenza A(H3N2) among elderly: awareness warranted for 2017/18 season. Euro Surveill. 2017;22(41).  https://doi.org/10.2807/1560-7917.ES.2017.22.41.17-00645  PMID: 29043961 
  39. Simpson CR, Lone NI, Kavanagh K, Robertson C, McMenamin J, von Wissmann B, et al. Evaluating the effectiveness, impact and safety of live attenuated and seasonal inactivated influenza vaccination: protocol for the Seasonal Influenza Vaccination Effectiveness II (SIVE II) study. BMJ Open. 2017;7(2):e014200.  https://doi.org/10.1136/bmjopen-2016-014200  PMID: 28246142 

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