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J Infect Dis. 2017 Oct 4. doi: 10.1093/infdis/jix526. [Epub ahead of print]
Beyond antigenic match: possible agent-host and immuno-epidemiological influences on influenza vaccine effectiveness during the 2015-16 season in Canada.
Skowronski DM1,2, Chambers C1, Sabaiduc S1, De Serres G3,4,5, Winter AL6, Dickinson JA7, Gubbay JB6,8, Drews SJ9,10, Martineau C3, Charest H3, Krajden M1,2, Bastien N11, Li Y11.
Author information
Abstract
Background:
Vaccine effectiveness (VE) estimates are reported from Canada's Sentinel Practitioner Surveillance Network (SPSN) for the 2015-16 influenza season, characterized by a delayed A(H1N1)pdm09 epidemic and concurrent B(Victoria) activity. Potential influences beyond antigenic match are explored including viral genomic variation, birth cohort effects, prior vaccination and epidemic period.
Methods:
VE was estimated by test-negative design comparing adjusted-odds ratio for influenza test-positivity among vaccinated vs. unvaccinated participants. Vaccine-virus relatedness was assessed by gene-sequencing and hemagglutination-inhibition assay.
Results:
Analyses included 596 influenza A(H1N1)pdm09 and 305 B(Victoria) cases compared to 926 test-negative controls. A(H1N1)pdm09 viruses were considered antigenically-related to vaccine (unchanged since 2009) despite phylogenetic clustering within emerging clade-6B.1. Adjusted-VE for A(H1N1)pdm09 was 43%(95%CI=25-57%), lower in adults born 1957-1976 (25%;95%CI=-16-51%); in those consecutively vaccinated both current and prior season (41%;95%CI=18-57%) vs. current season only (75%;95%CI=45-88%); and among participants presenting in March-April (19%;95%CI=-15-44%) vs. January-February 2016 (62%;95%CI=44-75%). VE for B(Victoria) viruses was 54%(95%CI=32-68%) despite lineage-level mismatch to B(Yamagata) vaccine and without further variation as observed for A(H1N1)pdm09.
Conclusions:
Influenza VE findings may require consideration of other agent-host and immuno-epidemiologic influences on vaccine performance beyond antigenic match, including viral genomic variation, birth (immunological) cohort and repeat vaccination effects, and potential within-season waning of vaccine protection.
KEYWORDS:
cohort effects; hemagglutination inhibition; influenza; influenza A subtype; influenza B lineage; influenza vaccine; original antigenic sin; repeat vaccination; sequencing; vaccine effectiveness
PMID: 29029166 DOI: 10.1093/infdis/jix526
Beyond antigenic match: possible agent-host and immuno-epidemiological influences on influenza vaccine effectiveness during the 2015-16 season in Canada.
Skowronski DM1,2, Chambers C1, Sabaiduc S1, De Serres G3,4,5, Winter AL6, Dickinson JA7, Gubbay JB6,8, Drews SJ9,10, Martineau C3, Charest H3, Krajden M1,2, Bastien N11, Li Y11.
Author information
Abstract
Background:
Vaccine effectiveness (VE) estimates are reported from Canada's Sentinel Practitioner Surveillance Network (SPSN) for the 2015-16 influenza season, characterized by a delayed A(H1N1)pdm09 epidemic and concurrent B(Victoria) activity. Potential influences beyond antigenic match are explored including viral genomic variation, birth cohort effects, prior vaccination and epidemic period.
Methods:
VE was estimated by test-negative design comparing adjusted-odds ratio for influenza test-positivity among vaccinated vs. unvaccinated participants. Vaccine-virus relatedness was assessed by gene-sequencing and hemagglutination-inhibition assay.
Results:
Analyses included 596 influenza A(H1N1)pdm09 and 305 B(Victoria) cases compared to 926 test-negative controls. A(H1N1)pdm09 viruses were considered antigenically-related to vaccine (unchanged since 2009) despite phylogenetic clustering within emerging clade-6B.1. Adjusted-VE for A(H1N1)pdm09 was 43%(95%CI=25-57%), lower in adults born 1957-1976 (25%;95%CI=-16-51%); in those consecutively vaccinated both current and prior season (41%;95%CI=18-57%) vs. current season only (75%;95%CI=45-88%); and among participants presenting in March-April (19%;95%CI=-15-44%) vs. January-February 2016 (62%;95%CI=44-75%). VE for B(Victoria) viruses was 54%(95%CI=32-68%) despite lineage-level mismatch to B(Yamagata) vaccine and without further variation as observed for A(H1N1)pdm09.
Conclusions:
Influenza VE findings may require consideration of other agent-host and immuno-epidemiologic influences on vaccine performance beyond antigenic match, including viral genomic variation, birth (immunological) cohort and repeat vaccination effects, and potential within-season waning of vaccine protection.
KEYWORDS:
cohort effects; hemagglutination inhibition; influenza; influenza A subtype; influenza B lineage; influenza vaccine; original antigenic sin; repeat vaccination; sequencing; vaccine effectiveness
PMID: 29029166 DOI: 10.1093/infdis/jix526
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