Seasonal influenza vaccine effectiveness in people with asthma: a national test-negative design case-control study.

BACKGROUND Influenza infection is an important trigger of asthma attacks. Influenza vaccination has the potential to reduce the incidence of influenza in people with asthma, but uptake remains persistently low, partially reflecting concerns about vaccine effectiveness (VE). METHODS We conducted a test-negative design case-control study to estimate the effectiveness of influenza vaccine in children and adults with asthma in Scotland over six influenza seasons (2010/11 to 2015/16). We used individual patient level data from 223 primary care practices which yielded 1,830,772 patient-years of data, which were linked with hospital and virological (n=5,910 swabs) data. RESULTS Vaccination was associated with an overall 55.0% (95% confidence interval (CI): 45.8-62.7) reduction in the risk of a laboratory-confirmed influenza infection in people with asthma over the six seasons. There was substantial variation in VE between seasons, influenza strains and age groups. The highest VE (76.1%; 95% CI: 55.6-87.1) was found in 2010/11 season where the A(H1N1) strain dominated and there was a good antigenic vaccine match. High protection was observed against A(H1N1) (e.g. 2010/11: 70.7%; 95%CI: 32.5-87.3) and B strains (e.g. 2010/11: 83.2%; 95%CI: 44.3-94.9), but there was lower protection for the A(H3N2) strain (e.g. 2014/15: 26.4%; 95%CI: -12.0-51.6). The highest VE against all viral strains was observed in adults aged 18-54 years (57.0%; 95%CI: 42.3-68.0). CONCLUSION Influenza vaccination gave meaningful protection against laboratory-confirmed influenza in people asthma across all six seasons. Strategies to boost influenza vaccine uptake has the potential to substantially reduce influenza triggered asthma attacks.

[1]  S. de Lusignan,et al.  Uptake and effectiveness of influenza vaccine in those aged 65 years and older in the United Kingdom, influenza seasons 2010/11 to 2016/17 , 2018, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[2]  M. Lipsitch,et al.  Measurement of Vaccine Direct Effects Under the Test-Negative Design. , 2018, American journal of epidemiology.

[3]  A. Sheikh,et al.  Influenza burden, prevention, and treatment in asthma‐A scoping review by the EAACI Influenza in asthma task force , 2018, Allergy.

[4]  J. Castilla,et al.  Asthma and influenza vaccination in elderly hospitalized patients: Matched case-control study in Spain , 2018, The Journal of asthma : official journal of the Association for the Care of Asthma.

[5]  L. Rosella,et al.  Vaccine effectiveness against laboratory-confirmed influenza hospitalizations among young children during the 2010-11 to 2013-14 influenza seasons in Ontario, Canada , 2017, PloS one.

[6]  Colin Simpson,et al.  Effectiveness of Influenza Vaccines in Asthma: A Systematic Review and Meta-Analysis , 2017, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[7]  A. Monto Moving Toward Improved Influenza Vaccines. , 2017, The Journal of infectious diseases.

[8]  Colin Simpson,et al.  Evaluating the effectiveness, impact and safety of live attenuated and seasonal inactivated influenza vaccination: protocol for the Seasonal Influenza Vaccination Effectiveness II (SIVE II) study , 2017, BMJ Open.

[9]  Joanna Ellis,et al.  Effectiveness of seasonal influenza vaccine for adults and children in preventing laboratory-confirmed influenza in primary care in the United Kingdom: 2015/16 end-of-season results , 2016, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[10]  J. Donnelly,et al.  Universal influenza vaccines: Shifting to better vaccines , 2016, Vaccine.

[11]  Alicia M. Fry,et al.  The case test-negative design for studies of the effectiveness of influenza vaccine in inpatient settings , 2016, International journal of epidemiology.

[12]  Joanna Ellis,et al.  Effectiveness of seasonal influenza vaccine in preventing laboratory-confirmed influenza in primary care in the United Kingdom: 2014/15 end of season results. , 2015, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[13]  Colin Simpson,et al.  Trivalent inactivated seasonal influenza vaccine effectiveness for the prevention of laboratory-confirmed influenza in a Scottish population 2000 to 2009. , 2015, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[14]  Richard K. Zimmerman,et al.  Influenza Vaccine Effectiveness in the United States During 2012–2013: Variable Protection by Age and Virus Type , 2014, The Journal of infectious diseases.

[15]  Benjamin J Cowling,et al.  Potential of the test-negative design for measuring influenza vaccine effectiveness: a systematic review , 2014, Expert review of vaccines.

[16]  C Moore,et al.  Effectiveness of trivalent seasonal influenza vaccine in preventing laboratory-confirmed influenza in primary care in the United Kingdom: 2012/13 end of season results. , 2014, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[17]  A. Monto,et al.  Influenza vaccine effectiveness in the 2011-2012 season: protection against each circulating virus and the effect of prior vaccination on estimates. , 2014, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[18]  D. Skowronski,et al.  The test-negative design: validity, accuracy and precision of vaccine efficacy estimates compared to the gold standard of randomised placebo-controlled clinical trials. , 2013, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[19]  Michael Haber,et al.  The case test-negative design for studies of the effectiveness of influenza vaccine. , 2013, Vaccine.

[20]  Jennifer C Nelson,et al.  The test-negative design for estimating influenza vaccine effectiveness. , 2013, Vaccine.

[21]  D. Fleming,et al.  Vaccine effectiveness of 2011/12 trivalent seasonal influenza vaccine in preventing laboratory-confirmed influenza in primary care in the United Kingdom: evidence of waning intra-seasonal protection. , 2013, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[22]  Harshana Liyanage,et al.  Reporting of Studies Conducted using Observational Routinely Collected Data (RECORD) statement: call for contributions from the clinical informatics community. , 2012, Informatics in primary care.

[23]  Nicholas S. Kelley,et al.  Efficacy and effectiveness of influenza vaccines: a systematic review and meta-analysis. , 2012, The Lancet. Infectious diseases.

[24]  Harish Nair,et al.  Global burden of respiratory infections due to seasonal influenza in young children: a systematic review and meta-analysis , 2011, The Lancet.

[25]  D. Fleming,et al.  Effectiveness of seasonal 2010/11 and pandemic influenza A(H1N1)2009 vaccines in preventing influenza infection in the United Kingdom: mid-season analysis 2010/11. , 2011, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[26]  Colin Simpson,et al.  Long-Term Trends in First Hospitalization for Heart Failure and Subsequent Survival Between 1986 and 2003: A Population Study of 5.1 Million People , 2009, Circulation.

[27]  M. Bergeron,et al.  Multiplex Real-Time PCR Assay for Detection of Influenza and Human Respiratory Syncytial Viruses , 2004, Journal of Clinical Microbiology.

[28]  Xiaolin Zhang,et al.  EFFECTIVENESS , 1977, Prospects for Constitutionalism in Post-Communist Countries.

[29]  K. Kusuhara,et al.  Trivalent cold recombinant influenza live vaccine in institutionalized children with bronchial asthma and patients with psychomotor retardation , 1993, The Pediatric infectious disease journal.

[30]  K. Kusuhara,et al.  Immunization of institutionalized asthmatic children and patients with psychomotor retardation using live attenuated cold-adapted reassortment influenza A H1N1, H3N2 and B vaccines. , 1993, Vaccine.