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PLoS ONE. Effectiveness of Pandemic H1N1-2009 Vaccination in Reducing Laboratory Confirmed Influenza Infections among Military Recruits in Tropical Singapore

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  • PLoS ONE. Effectiveness of Pandemic H1N1-2009 Vaccination in Reducing Laboratory Confirmed Influenza Infections among Military Recruits in Tropical Singapore

    [Source: PLoS ONE, full text: (LINK). Abstract, edited.]
    Effectiveness of Pandemic H1N1-2009 Vaccination in Reducing Laboratory Confirmed Influenza Infections among Military Recruits in Tropical Singapore



    Vernon J. Lee<SUP>1</SUP><SUP>,</SUP><SUP>2</SUP><SUP>,</SUP><SUP>3</SUP><SUP>,</SUP><SUP>4</SUP><SUP>*</SUP>, Chi Hsien Tan<SUP>1</SUP>, Jonathan Yap<SUP>1</SUP>, Alex R. Cook<SUP>5</SUP>, Pei-Jun Ting<SUP>6</SUP>, Jin-Phang Loh<SUP>6</SUP>, Qiuhan Gao<SUP>1</SUP>, Mark I. Chen<SUP>3</SUP><SUP>,</SUP><SUP>7</SUP>, Wee Lee Kang<SUP>8</SUP>, Boon Huan Tan<SUP>6</SUP>, Paul A. Tambyah<SUP>9</SUP>

    1 Biodefence Centre, Ministry of Defence, Singapore, Singapore, 2 Centre for Health Services Research, National University of Singapore, Singapore, Singapore, 3 Department of Epidemiology and Public Health, National University of Singapore, Singapore, Singapore, 4 National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia, 5 Department of Statistics and Applied Probability, National University of Singapore, Singapore, Singapore, 6 Defence Medical and Environmental Research Institute, DSO National Laboratories, Singapore, Singapore, 7 Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore, 8 Headquarters Medical Corps, Singapore Armed Forces, Singapore, Singapore, 9 Department of Infectious Diseases, National University Health System, Singapore, Singapore


    Abstract

    Background

    Limited information is available about pandemic H1N1-2009 influenza vaccine effectiveness in tropical communities. We studied the effectiveness of a pandemic H1N1 vaccination program in reducing influenza cases in Singapore.


    Methods

    A surveillance study was conducted among military personnel presenting with febrile respiratory illness from mid-2009 to mid-2010. Consenting individuals underwent nasal washes, which were tested with RT-PCR and subtyped. A vaccination program (inactivated monovalent Panvax H1N1-2009 vaccine) was carried out among recruits. A Bayesian hierarchical model was used to quantify relative risks in the pre- and post-vaccination periods. An autoregressive generalised linear model (GLM) was developed to minimise confounding.


    Results

    Of 2858 participants, 437(15.3%), 60(2.1%), and 273(9.6%) had pandemic H1N1, H3N2, and influenza B. The ratio of relative risks for pandemic H1N1 infection before and after vaccination for the recruit camp relative to other camps was 0.14(0.016,0.49); for H3N2, 0.44(0.035,1.8); and for influenza B, 18(0.77,89). Using the GLM for the recruit camp, post-vaccination weekly cases decreased by 54%(37%,67%, p<0.001) from that expected without vaccination; influenza B increased by 66 times(9?479 times, p<0.001); with no statistical difference for H3N2 (p = 0.54).


    Conclusions

    Pandemic vaccination reduced H1N1-2009 disease burden among military recruits. Routine seasonal influenza vaccination should be considered.


    Citation: Lee VJ, Tan CH, Yap J, Cook AR, Ting P-J, et al. (2011) Effectiveness of Pandemic H1N1-2009 Vaccination in Reducing Laboratory Confirmed Influenza Infections among Military Recruits in Tropical Singapore. PLoS ONE 6(10): e26572. doi:10.1371/journal.pone.0026572

    Editor: Gavin J. D. Smith, Duke-NUS Graduate Medical School, Singapore

    Received: May 28, 2011; Accepted: September 29, 2011; Published: October 28, 2011

    Copyright: ? 2011 Lee et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    Funding: This work was supported by a Singapore Ministry of Defense funded operational research program. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

    Competing interests: The authors have read the journal's policy and have the following conflicts: VJL has received unrelated research support from GSK. PAT has received research support and honoraria from Baxter, Adamas, Merlion Pharma, and Novartis as well as travel support from Pfizer and Wyeth and sits on the boards of the Asia Pacific Advisory Committee on Influenza and the Asian Hygiene Council. ARC has received unrelated research funding from the National University of Singapore. The rest of the authors declare that we do not have any conflict of interests, financial or otherwise, in this study. VJL and ARC are academic editors of PLoS One. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials.

    * E-mail: vernonljm@hotmail.com
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