Angela M C Rose1, Esther Kissling1, Alin Gherasim2, Itziar Casado3, Antonino Bella4, Odile Launay5,6, Mihaela Lazăr7, Sierk Marbus8, Monika Kuliese9, Ritva Syrjänen10, Ausenda Machado11, Sanja Kurečić Filipović12, Amparo Larrauri2, Jesús Castilla3, Valeria Alfonsi4, Florence Galtier5,13, Alina Ivanciuc7, Adam Meijer8, Aukse Mickiene9, Niina Ikonen14, Verónica Gómez11, Zvjezdana Lovrić Makarić12, Alain Moren1, Marta Valenciano1. 1. Epiconcept, Paris, France. 2. National Centre of Epidemiology, CIBERESP, Institute of Health Carlos III, Madrid, Spain. 3. Navarra Public Health Institute, IdiSNA-CIBERESP, Pamplona, Spain. 4. Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy. 5. Inserm, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), Paris, France. 6. CIC Cochin Pasteur, université Paris Descartes, Sorbonne Paris Cité, hôpital Cochin, AP-HP, Paris, France. 7. National Military-Medical Institute for Research and Development, Bucharest, Romania. 8. National Institute for Public Health and the Environment, Bilthoven, The Netherlands. 9. Department of Infectious diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania. 10. Finnish Institute for Health and Welfare, Tampere, Finland. 11. Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal. 12. Division for epidemiology of communicable diseases, Croatian Institute of Public Health, Zagreb, Croatia. 13. CHU de Montpellier, Inserm CIC 1411, Hôpital Saint-Eloi, Montpellier, France. 14. Finnish Institute for Health and Welfare, Helsinki, Finland.
Abstract
BACKGROUND: Influenza A(H3N2), A(H1N1)pdm09 and B viruses co-circulated in Europe in 2017-18, predominated by influenza B. WHO-recommended, trivalent vaccine components were lineage-mismatched for B. The I-MOVE hospital network measured 2017-18 seasonal influenza vaccine effectiveness (IVE) against influenza A(H3N2) and B among hospitalised patients (≥65 years) in Europe. METHODS: Following the same generic protocol for test-negative design, hospital teams in nine countries swabbed patients ≥65 years with recent onset (≤7 days) severe acute respiratory infection (SARI), collecting information on demographics, vaccination status and underlying conditions. Cases were RT-PCR positive for influenza A(H3N2) or B; controls: negative for any influenza. "Vaccinated" patients had SARI onset >14 days after vaccination. We measured pooled IVE against influenza, adjusted for study site, age, sex, onset date and chronic conditions. RESULTS: We included 3483 patients: 376 influenza A(H3N2) and 928 B cases, and 2028 controls. Most (>99%) vaccinated patients received the B lineage-mismatched trivalent vaccine. IVE against influenza A(H3N2) was 24% (95% CI: 2 to 40); 35% (95% CI: 6 to 55) in 65- to 79-year-olds and 14% (95% CI: -22 to 39) in ≥80-year-olds. Against influenza B, IVE was 30% (95% CI: 16 to 41); 37% (95% CI: 19 to 51) in 65- to 79-year-olds and 19% (95% CI: -7 to 38) in ≥80-year-olds. CONCLUSIONS: IVE against influenza B was similar to A(H3N2) in hospitalised older adults, despite trivalent vaccine and circulating B lineage mismatch, suggesting some cross-protection. IVE was lower in those ≥80 than 65-79 years. We reinforce the importance of influenza vaccination in older adults as, even with a poorly matched vaccine, it still protects one in three to four of this population from severe influenza.
BACKGROUND:Influenza A(H3N2), A(H1N1)pdm09 and B viruses co-circulated in Europe in 2017-18, predominated by influenzaB. WHO-recommended, trivalent vaccine components were lineage-mismatched for B. The I-MOVE hospital network measured 2017-18 seasonal influenza vaccine effectiveness (IVE) against influenza A(H3N2) and B among hospitalised patients (≥65 years) in Europe. METHODS: Following the same generic protocol for test-negative design, hospital teams in nine countries swabbed patients ≥65 years with recent onset (≤7 days) severe acute respiratory infection (SARI), collecting information on demographics, vaccination status and underlying conditions. Cases were RT-PCR positive for influenza A(H3N2) or B; controls: negative for any influenza. "Vaccinated" patients had SARI onset >14 days after vaccination. We measured pooled IVE against influenza, adjusted for study site, age, sex, onset date and chronic conditions. RESULTS: We included 3483 patients: 376 influenza A(H3N2) and 928 B cases, and 2028 controls. Most (>99%) vaccinated patients received the B lineage-mismatched trivalent vaccine. IVE against influenza A(H3N2) was 24% (95% CI: 2 to 40); 35% (95% CI: 6 to 55) in 65- to 79-year-olds and 14% (95% CI: -22 to 39) in ≥80-year-olds. Against influenzaB, IVE was 30% (95% CI: 16 to 41); 37% (95% CI: 19 to 51) in 65- to 79-year-olds and 19% (95% CI: -7 to 38) in ≥80-year-olds. CONCLUSIONS: IVE against influenzaB was similar to A(H3N2) in hospitalised older adults, despite trivalent vaccine and circulating B lineage mismatch, suggesting some cross-protection. IVE was lower in those ≥80 than 65-79 years. We reinforce the importance of influenza vaccination in older adults as, even with a poorly matched vaccine, it still protects one in three to four of this population from severe influenza.
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