Influenza vaccine effectiveness against hospitalization with laboratory-confirmed influenza in Greece: A pooled analysis across six seasons, 2013–2014 to 2018–2019 |
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| Institution: | 1. National Public Health Organization, Athens, Greece;2. European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden;3. National Influenza Centre for Northern Greece, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece;4. National Influenza Centre for Southern Greece, Hellenic Pasteur Institute, Athens, Greece;1. Epidemiology and Disease Control Division, Ministry of Health, Singapore;2. Communicable Disease Division, Ministry of Health, Singapore;3. National Public Health Laboratory, Ministry of Health, Singapore;1. Victorian Infectious Diseases Reference Laboratory, The Doherty Institute, Melbourne, Victoria, Australia;2. National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia;3. Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia;4. PathWest Laboratory Medicine WA, Perth, Western Australia, Australia;5. School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia;6. Discipline of General Practice, University of Adelaide, Adelaide, South Australia, Australia;7. World Health Organization Collaborating Centre for Reference and Research on Influenza, The Doherty Institute, Melbourne, Victoria, Australia;8. Communicable Disease Control Directorate, Western Australia Department of Health, Perth, Western Australia, Australia;9. Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA;1. Department of Pediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China;2. WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China;3. Department of Microbiology, The University of Hong Kong, Hong Kong Special Administrative Region, China;4. Public Health Laboratory Services Branch, Centre for Health Protection, Department of Health, China;5. Department of Pediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong Special Administrative Region, China;6. Centre of Influenza Research, The University of Hong Kong, Hong Kong Special Administrative Region, China;1. The University of Otago, Wellington, PO Box 7343, Wellington South 6242, New Zealand;2. The Australian National University, Canberra 0200, ACT Australia;3. Victorian Infectious Diseases Reference Laboratory, Melbourne, VIC, Australia;4. Institute of Environmental Science and Research, Upper Hutt Wellington, New Zealand;5. The University of Auckland, Private Bag 92019, Victoria St West, Auckland, New Zealand;6. Centers for Disease Control and Prevention, Atlanta, GA 30333, USA;1. Instituto de Salud Pública de Navarra, IdiSNA–Navarra Institute for Health Research, Pamplona, Spain;2. CIBER Epidemiología y Salud Pública (CIBERESP), Spain;3. Complejo Hospitalario de Navarra, IdiSNA–Navarra Institute for Health Research, Pamplona, Spain;4. Clínica Universidad de Navarra, IdiSNA–Navarra Institute for Health Research, Pamplona, Spain;5. Centro Nacional de Microbiología (WHO National Influenza Centre–Madrid), Instituto de Salud Carlos III, Majadahonda, Spain;1. Istituto Superiore di Sanità, Rome, Italy;2. Dipartimento Scienze biomediche ed oncologia umana, Università degli Studi di Bari Aldo Moro, Bari, Italy;3. Dipartimento di Scienze biomediche per la salute, Università degli Studi di Milano, Milan, Italy;4. Governo della Prevenzione e tutela sanitaria, Regione Lombardia, Milan, Italy;5. SeREMI ASL AL, Servizio Riferimento Regionale, Epidemiologia Malattie Infettive, Alessandria, Italy;6. Ospedale “Amedeo di Savoia”- Torino, Italy;7. Servizio Sanità pubblica, D. G. Sanità e Politiche sociali, Regione Emilia-Romagna, Bologna, Italy;8. Dipartimento di Scienze Biomediche, Biotecnologiche e Traslazionali, Università degli Studi di Parma, Italy |
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| Abstract: | BackgroundMonitoring seasonal influenza Vaccine Effectiveness (VE) is key to inform vaccination strategies and sustain uptake. Pooling data across multiple seasons increases precision and allows for subgroup analyses, providing more conclusive evidence. Our aim was to assess VE against hospitalization with laboratory-confirmed influenza in Greece over six seasons, from 2013 to 2014 to 2018–2019, using routinely collected surveillance data.MethodsSwab samples from hospitalized patients across the country were tested for influenza by RT-PCR. We used the test-negative design, with patients testing positive for influenza serving as cases and those testing negative serving as controls. VE was calculated as one minus the Odds Ratio (OR) for influenza vaccination, estimated by mixed-effects logistic regression and adjusted for age, sex, hospitalization type (being in intensive care or not), time from symptom onset to swabbing, and calendar time. Stratified estimates by age and hospitalization type were obtained, and also subgroup estimates by influenza type/subtype and season. Antigenic and genetic characterization of a subset of circulating influenza strains was performed.ResultsA total of 3,882 test-positive cases and 5,895 test-negative controls were analyzed. Across all seasons, adjusted VE was 45.5% (95% CI: 31.6–56.6) against all influenza, 62.8% against A(H1N1)pdm09 (95% CI: 40.7–76.7), 28.2% against A(H3N2) (95% CI: 12.0–41.3) and 45.5% against influenza B (95% CI: 29.1–58.1). VE was slightly lower for patients aged 60 years and over, and similar between patients hospitalized inside or outside intensive care. Circulating A(H1N1)pdm09 and B strains were antigenically similar to the vaccine strains, whereas A(H3N2) were not.ConclusionOur results confirm the public health benefits from seasonal influenza vaccination, despite the suboptimal effectiveness against A(H3N2) strains. Continued monitoring of VE is essential, and routinely collected surveillance data can be valuable in this regard. |
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| Keywords: | Influenza surveillance Vaccine effectiveness Viral subtypes Epidemiology |
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