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Influenza vaccine effectiveness in Europe and the birth cohort effect against influenza A(H1N1)pdm09: VEBIS primary care multicentre study, 2023/24
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Esther Kissling1,2,*
, Marine Maurel1,* , Francisco Pozo3,4 , Gloria Pérez-Gimeno4,5 , Silke Buda6 , Noémie Sève7 , Lisa Domegan8 , Mariëtte Hooiveld9 , Beatrix Oroszi10 , Iván Martínez-Baz4,11 , Raquel Guiomar12 , Neus Latorre-Margalef13 , Ivan Mlinarić14
, Mihaela Lazar15 , Jaume Giménez Duran16 , Ralf Dürrwald6 , Vincent Enouf17 , Adele McKenna8 , Marit de Lange18 , Gergő Túri10 , Camino Trobajo-Sanmartín4,11 , Verónica Gomez19 , Tove Samuelsson Hagey13 , Vesna Višekruna Vučina14
, Maria Carmen Cherciu15 , Miriam García Vazquez20 , Annika Erdwiens6 , Shirley Masse21 , Charlene Bennett22 , Adam Meijer18
, Katalin Kristóf23 , Jesús Castilla4,11 , Ana Paula Rodrigues19 , Sanja Kurečić Filipović14
, Alina Elena Ivanciuc15 , Sabrina Bacci24 , Marlena Kaczmarek24 , on behalf of the European primary care VE group25
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View Affiliations Hide AffiliationsAffiliations: 1 Epiconcept, Paris, France 2 University of Antwerp, Antwerp, Belgium 3 National Centre for Microbiology, National Influenza Reference Laboratory, WHO-National Influenza Centre, Institute of Health Carlos III, Madrid, Spain 4 CIBER de Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid, Spain 5 National Centre of Epidemiology, Institute of Health Carlos III, Madrid, Spain 6 Robert Koch Institute, Berlin, Germany 7 Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP), F75012, Paris, France 8 Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland 9 Nivel, Utrecht, the Netherlands 10 National Laboratory for Health Security, Epidemiology and Surveillance Centre, Semmelweis University, Budapest, Hungary 11 Instituto de Salud Pública de Navarra – IdiSNA, Pamplona, Spain 12 Laboratório Nacional Referência Gripe e outros Vírus Respiratórios, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal 13 Department of Microbiology, Public Health Agency of Sweden, Stockholm, Sweden 14 Division for Epidemiology of Communicable Diseases, Croatian Institute of Public Health, Zagreb, Croatia 15 National Influenza Centre, Cantacuzino National Military-Medical Institute for Research and Development, Bucharest, Romania 16 Servicio de Epidemiologia DG Salut Pública, IDISBA (Instituto de Investigaciones Sanitarias de Baleares), Illes Balears, Spain 17 Centre National de Référence Virus des Infections Respiratoire (CNR VIR), M3P unit, Institut Pasteur Université Paris Cité, Paris, France 18 National Institute for Public Health and the Environment, Centre for Infectious Diseases Control, Bilthoven, the Netherlands 19 Epidemiology Department, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal 20 Sección de Vigilancia Epidemiológica de la Dirección General de Salud Pública, Aragón, Spain 21 Unite des Virus Emergents (UVE: Aix-Marseille Univ, Universita di Corsica, IRD 190, Inserm 1207, IRBA), Marseille, France 22 National Virus Reference Laboratory, University College Dublin, Dublin, Ireland 23 Institute of Laboratory Medicine, Semmelweis University, Budapest, Hungary 24 European Centre for Disease Prevention and Control, Stockholm, Sweden 25 The members of the European primary care VE group are acknowledged at the end of the article * These authors contributed equally to this work and share first authorship.Esther Kisslinge.kissling epiconcept.fr
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Citation style for this article: Kissling Esther, Maurel Marine, Pozo Francisco, Pérez-Gimeno Gloria, Buda Silke, Sève Noémie, Domegan Lisa, Hooiveld Mariëtte, Oroszi Beatrix, Martínez-Baz Iván, Guiomar Raquel, Latorre-Margalef Neus, Mlinarić Ivan, Lazar Mihaela, Giménez Duran Jaume, Dürrwald Ralf, Enouf Vincent, McKenna Adele, de Lange Marit, Túri Gergő, Trobajo-Sanmartín Camino, Gomez Verónica, Samuelsson Hagey Tove, Višekruna Vučina Vesna, Cherciu Maria Carmen, García Vazquez Miriam, Erdwiens Annika, Masse Shirley, Bennett Charlene, Meijer Adam, Kristóf Katalin, Castilla Jesús, Rodrigues Ana Paula, Kurečić Filipović Sanja, Ivanciuc Alina Elena, Bacci Sabrina, Kaczmarek Marlena, on behalf of the European primary care VE group. Influenza vaccine effectiveness in Europe and the birth cohort effect against influenza A(H1N1)pdm09: VEBIS primary care multicentre study, 2023/24. Euro Surveill. 2025;30(23):pii=2500011. https://doi.org/10.2807/1560-7917.ES.2025.30.23.2500011 Received: 23 Dec 2024; Accepted: 07 Apr 2025
Abstract
Influenza A(H1N1)pdm09, A(H3N2) and B/Victoria viruses circulated in Europe in 2023/24, with A(H1N1)pdm09 dominance. First influenza infections in childhood may lead to different vaccine effectiveness (VE) in subsequent years.
The VEBIS primary care network estimated influenza VE in Europe using a multicentre test‐negative study.
Primary care practitioners collected information and specimens from patients consulting with acute respiratory infection. We estimated VE against influenza (sub)type and clade, by age group and by year of age for A(H1N1)pdm09, using logistic regression.
We included 29,958 patients, with 3,054, 1,053 and 311 influenza A(H1N1)pdm09, A(H3N2) and B cases, respectively. All-age VE against influenza A(H1N1)pdm09 was 52% (95% CI: 44–59). By year of age, VE was 27% (95% CI: −2 to 47) at 44 years with peaks at 72% (95% CI: 52–84) and 54% (95% CI: 41–64) among children and those 65 years and older, respectively. All-age A(H1N1)pdm09 VE against clade 5a.2a was 41% (95% CI: 24–54) and −11% (95% CI: −69 to 26) against clade 5a.2a.1. The A(H3N2) VE was 35% (95% CI: 20–48) among all ages and ranged between 34% and 40% by age group. All-age VE against clade 2a.3a.1 was 38% (95% CI: 1–62). All-age VE against B/Victoria was 83% (95% CI: 65–94), ranging between 70 and 92% by age group.
The 2023/24 VEBIS primary care VE against medically attended symptomatic influenza infection was high against influenza B/Victoria, but lower against influenza A(H1N1)pdm09 and A(H3N2). Clade- and age-specific effects may have played a role in the lower A(H1N1)pdm09 VE.

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