Effectiveness of the current and prior influenza vaccinations in Northern Spain, 2018–2019

doi:10.1016/j.vaccine.2020.01.028

Vaccine

Volume 38, Issue 8, 18 February 2020, Pages 1925-1932

https://doi.org/10.1016/j.vaccine.2020.01.028 Get rights and content

Highlights

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The current and prior influenza vaccination effectiveness was evaluated in 2018/19.
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Vaccine effectiveness was moderate against A/H1N1 and low against A/H3N2 influenza.
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Vaccination in prior seasons maintained a notable protective effect.
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Strains included in recent prior vaccines were as effective as the current vaccine strain.
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Current and prior vaccines added their effects against influenza A/H1N1.

Abstract

Background

The population targeted for influenza vaccination can be repeatedly vaccinated over successive seasons, and vaccines received in previous seasons may retain preventive effect. This study aims to estimate the effectiveness of inactivated influenza vaccines received in the current and prior seasons in the 2018–2019 season.

Methods

Influenza-like illness patients attended by sentinel general practitioners or admitted to hospitals in Navarre, Spain, were tested for influenza. Vaccination status in the current and three prior seasons was obtained from the vaccination registry. The test-negative design was used to estimate the vaccine effectiveness.

Results

A total of 381 influenza A(H1N1)pdm09 cases, 341 A(H3N2) cases and 1222 controls were analysed. As compared to individuals unvaccinated in the current and three prior seasons, the influenza vaccine effectiveness against A(H1N1)pdm09 was 57% (95% confidence interval [CI]: 40%, 70%) for current season vaccination regardless of prior doses and 48% (95%CI: 14%, 68%) for vaccination in prior seasons but not in the current season. These estimates were 12% (95%CI: −23%, 37%) and 27% (95%CI: −22%, 56%), respectively, against influenza A(H3N2). Individuals vaccinated with the two A(H1N1)pdm09 strains in influenza vaccines since 2009, A/Michigan/45/2015 and A/California/07/2009, had higher protection (68%; 95%CI: 53%, 77%) than those vaccinated with A/Michigan/45/2015 only (29%, p = 0.020) or with A/California/07/2009 only (34%, p = 0.005).

Conclusion

These results suggest moderate effectiveness of influenza vaccination against A(H1N1)pdm09 and low effectiveness against A(H3N2) influenza in the 2018–2019 season. Vaccination in prior seasons maintained a notable protective effect. Strains included in previous vaccines were as effective as the current vaccine strain, and both added their effects against influenza A(H1N1)pdm09.

Introduction

During the 2018–2019 season, influenza A(H1N1)pdm09 and A(H3N2) co-circulated in Spain and in other European countries [1], [2]. Interim estimates from different countries showed moderate to high influenza vaccine effectiveness (VE) against influenza A(H1N1)pdm09 viruses, and low to moderate VE against influenza A(H3N2) [3], [4], [5], [6]. All these interim studies evaluated the effect of the current season vaccine, but they did not consider vaccination history in prior seasons.

The population targeted for influenza vaccination can be repeatedly vaccinated over successive seasons, and the components of successive vaccines may remain the same or may change [7], [8], [9]. Vaccines received in previous seasons may retain some preventive effect [10], [11], and sometimes may modify the effect of the current season vaccine [12], [13], [14]. Most studies evaluating influenza VE only consider whether participants were vaccinated in the current season or not, without taking into account past vaccination history [15]. Of those that have assessed past vaccination history, only a few have considered vaccination in more than one prior season, since this requires good vaccination registers covering stable populations during several years [16], [17]. The effect of influenza vaccination in the current and prior seasons may depend on the matching between the strain included in each vaccine and the currently circulating strain; therefore the evaluation by influenza virus subtype may be refined by considering the strain components which were included in the vaccine of each season [18], [19], [20], [21].

We aimed to estimate the effectiveness of influenza vaccines received in the current and prior seasons in preventing cases of influenza A(H1N1)pdm09 and A(H3N2) in the 2018–2019 season in Navarre, Spain. The effectiveness was also evaluated for specific strains included in influenza vaccines of the current and prior seasons.

Section snippets

Study design, setting and information sources

A test-negative case-control study was carried out in primary healthcare centres and hospitals in Navarre, Spain. The Navarre Ethical Committee for Medical Research approved the study protocol.

In October and November 2018, the trivalent inactivated vaccine (Afluria, Seqirus) was offered free of charge to the target population for vaccination, which included people aged 60 years or over and people with underlying medical conditions [22]. Other people could also be vaccinated if they purchased

Results

A total of 1957 ILI patients were included in this study, of whom 1405 (72%) were hospitalized patients and 552 were outpatients. A total of 735 (38%) were confirmed cases for influenza: 381 A(H1N1)pdm09, 341 A(H3N2), nine A not subtyped and four influenza B. The cases were compared to 1222 influenza-negative controls.

Compared with test-negative controls, influenza cases had a lower proportion of persons aged 65 years or older, persons with comorbidities and those who were treated in hospital.

Discussion

The results show a VE for the current season inactivated influenza vaccination regardless of prior vaccinations of 57% against influenza A(H1N1)pdm09 and 12% against A(H3N2) in the 2018–2019 season in Navarre. Interestingly, vaccination in any prior season but not in the current one was 48% effective against A(H1N1)pdm09 and 27% against A(H3N2). Therefore, those with no current but any prior season vaccination had a similar VE against any influenza virus to those vaccinated in the current

Conclusions

These results suggest moderate influenza VE against influenza A(H1N1)pdm09 and low VE against A(H3N2) in the 2018–2019 season. Influenza vaccines received in prior seasons maintained a notable protective effect. Strains included in recent previous vaccines were as effective as the current vaccine strain, and both added their effects against influenza A(H1N1)pdm09. Depending on the circulating virus strain, prior season vaccination might be as protective as the current season vaccination. In any

Funding sources

This study was supported by the I-MOVE Network (Influenza Monitoring Vaccine Effectiveness in Europe) funded by the European Centre for Disease Prevention and Control; and by the Carlos III Institute of Health with the European Regional Development Fund (PI17/00868).

CRediT authorship contribution statement

Jesús Castilla: Conceptualization, Methodology, Writing - original draft. María Eugenia Portillo: Investigation, Validation. Itziar Casado: Investigation, Data curation. Francisco Pozo: Investigation, Validation. Ana Navascués: Investigation, Validation. Marta Adelantado: Investigation, Validation. Carlos Gómez Ibáñez: Investigation, Data curation. Carmen Ezpeleta: Supervision. Iván Martínez-Baz: Conceptualization, Methodology, Writing - review & editing.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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Cited by (8)

Does repeated influenza vaccination attenuate effectiveness? A systematic review and meta-analysis
2023, The Lancet Respiratory Medicine
Citation Excerpt :
However, results were inconsistent, and increased vaccine effectiveness with an increased number of previous vaccinations was observed for three (20%) of 15 estimates, even for influenza A(H3N2). Multiple previous season vaccine effectiveness was also studied across three,46,51,70,74,96 four,49,58 five,22,50,66,70,71,80 six,69 and ten previous seasons.66 Generally, we identified no consensus trend of vaccine effectiveness with increasing vaccinations in previous seasons.
Influenza vaccines require annual readministration; however, several reports have suggested that repeated vaccination might attenuate the vaccine's effectiveness. We aimed to estimate the reduction in vaccine effectiveness associated with repeated influenza vaccination.
In this systematic review and meta-analysis, we searched MEDLINE, EMBASE, and CINAHL Complete databases for articles published from Jan 1, 2016, to June 13, 2022, and Web of Science for studies published from database inception to June 13, 2022. For studies published before Jan 1, 2016, we consulted published systematic reviews. Two reviewers (EJ-G and EJR) independently screened, extracted data using a data collection form, assessed studies' risk of bias using the Risk Of Bias In Non-Randomized Studies of Interventions (ROBINS-I) and evaluated the weight of evidence by Grading of Recommendations Assessment, Development, and Evaluation (GRADE). We included observational studies and randomised controlled trials that reported vaccine effectiveness against influenza A(H1N1)pdm09, influenza A(H3N2), or influenza B using four vaccination groups: current season; previous season; current and previous seasons; and neither season (reference). For each study, we calculated the absolute difference in vaccine effectiveness (ΔVE) for current season only and previous season only versus current and previous season vaccination to estimate attenuation associated with repeated vaccination. Pooled vaccine effectiveness and ∆VE were calculated by season, age group, and overall. This study is registered with PROSPERO, CRD42021260242.
We identified 4979 publications, selected 681 for full review, and included 83 in the systematic review and 41 in meta-analyses. ΔVE for vaccination in both seasons compared with the current season was –9% (95% CI –16 to –1, I²=0%; low certainty) for influenza A(H1N1)pdm09, –18% (–26 to –11, I²=7%; low certainty) for influenza A(H3N2), and –7% (–14 to 0, I²=0%; low certainty) for influenza B, indicating lower protection with consecutive vaccination. However, for all types, A subtypes and B lineages, vaccination in both seasons afforded better protection than not being vaccinated.
Our estimates suggest that, although vaccination in the previous year attenuates vaccine effectiveness, vaccination in two consecutive years provides better protection than does no vaccination. The estimated effects of vaccination in the previous year are concerning and warrant additional investigation, but are not consistent or severe enough to support an alternative vaccination regimen at this time.
WHO and the US National Institutes of Health.
Influenza vaccine hesitancy among healthcare workers in Spain: Results of a survey
2022, Vacunas
el objetivo de este estudio fue identificar los factores que más contribuyen a la reticencia hacia la vacunación contra la gripe en los profesionales sanitarios.
estudio descriptivo transversal mediante una encuesta cuantitativa online a profesionales sanitarios a nivel nacional, estratificando por centro de trabajo y perfil profesional, y utilizando los canales más adecuados de distribución a nivel autonómico. El trabajo de campo tuvo lugar entre el 17 de febrero y el 31 de marzo de 2020.
se recogieron 11.108 encuestas. Los aspectos valorados acerca de la vacunación frente a la gripe en los profesionales sanitarios son bien conocidos (> 85%), siendo menor en auxiliares de enfermería y otro personal sanitario. El personal sanitario joven se vacuna menos, tiene menor percepción del riesgo y reconoce menos su papel como transmisor que como receptor. El personal sanitario recomienda la vacunación de forma desigual a los diferentes grupos diana. Todos los perfiles demandan campañas de información con mensajes comunes. Haberse vacunado previamente, junto a la formación/docencia en vacunas, son los motivos más relacionados con vacunarse o la recomendación de vacunación.
la confianza de la población general en la recomendación que realiza el personal sanitario es el principal elemento para decidir a favor de la vacunación frente a la gripe. Es necesario desarrollar estrategias integrales, formativas e informativas, participadas, dirigidas a la población diana e incorporando los resultados distintivos identificados, que consigan mejorar las coberturas de vacunación en todos los grupos en los que se recomienda la vacunación frente a la gripe.
To identify the factors most closely related to hesitancy to influenza vaccination in healthcare workers.
Cross-sectional descriptive study using a quantitative online survey in healthcare workers nationwide, stratifying by workplace and professional profile and using the most appropriate distribution channels at the regional level. The fieldwork took place from February 17 to March 31, 2020.
11,108 surveys were collected. There is good knowledge about influenza vaccination in healthcare workers (percentages higher than 85%), being less in nursery and other healthcare workers. Younger personnel have a lower perception of risk and less vaccination, they recognize their role as receptors but less as transmission agents (statistical significance). The recommendation is heterogeneous between the different target groups in all healthcare workers. Information campaigns with common messages are highly demanded. Previous vaccinations joined to training/teaching in vaccines are the most closely reasons related with current vaccination or recommendation to vaccinate.
Confidence in the recommendation of healthcare workers is the main factor that leading to vaccination against influenza in the population. It is necessary to develop comprehensive, educational and informative, participatory strategies, aimed at the target population and incorporating the identified distinctive results, which are able to improve vaccination coverage in all groups in which influenza vaccination is recommended.
Variable seasonal influenza vaccine effectiveness across geographical regions, age groups and levels of vaccine antigenic similarity with circulating virus strains: A systematic review and meta-analysis of the evidence from test-negative design studies after the 2009/10 influenza pandemic
2021, Vaccine
Citation Excerpt :
The specific age ranges included in each of the a priori determined age categories for pooled VE by age is detailed in Supplementary Table 3. From a total 11,931 identified citations, 76 full-text articles met our eligibility criteria for inclusion (Fig. 1) [15–90]. These articles comprised 13 articles from Spain [18–20,32,33,37–40,46–48,71], 12 articles from the USA [16,23,29–31,36,51,54,65,70,83,90], ten articles from Australia [17,26,27,41–43,67,68,80,81], eight articles from the UK [15,55–61], seven articles from Canada [71–78], four articles from China [45,86,88], three articles from Germany [25,35,52], two articles each from Israel [79,89], Japan [22,82], Netherlands [24,84], Romania [63,64], and South Africa [49,50], and one article each from Austria [66], Croatia [28], France [85], Hong Kong [21], Italy [69], New Zealand [62], Portugal [53], Taiwan [44], and Turkey [34].
We examined the influence of some factors on seasonal influenza vaccine effectiveness (VE) from test-negative design (TND) studies.
We systematically searched for full-text publications of VE against laboratory-confirmed influenza from TND studies in outpatient settings after the 2009/10 influenza pandemic. Two reviewers independently selected and extracted data from the included studies. We calculated pooled adjusted VE across geographical regions, age groups and levels of vaccine antigenic similarity with circulating virus strains, using an inverse variance, random-effects model.
We included 76 full-text articles from 11,931 citations. VE estimates against A(H1N1)pdm09, A(H3N2), influenza B, and all influenza were homogenous and point pooled VE higher in the Southern hemisphere compared with the Northern hemisphere. The difference in pooled VE between the Southern and Northern hemispheres was statistically significant for A(H3N2), influenza B, and all influenza. A consistent pattern was observed in pooled VE across both hemispheres and continents, with the highest point pooled VE being against A(H1N1)pdm09, followed by influenza B, and lowest against A(H3N2). A nearly consistent pattern was observed in pooled VE across age groups in the Northern hemisphere, with pooled VE mostly decreasing with age. Point pooled VE against A(H3N2), influenza B, and all influenza were statistically significantly higher when vaccine was antigenically similar to circulating virus strains compared with when antigenically dissimilar. Similar pattern was observed in the Northern hemisphere, but there was a lack of data from the Southern hemisphere.
Consistent patterns appear to exist in seasonal influenza VE across regions, age groups, and levels of vaccine antigenic similarity with circulating virus strains, with best vaccine performance against A(H1N1)pdm09 and worst against A(H3N2). The evidence highlights the need to consider geographical location, age, and vaccine antigenic similarity with circulating virus strains when designing and evaluating influenza VE studies.
Influenza vaccine effectiveness against influenza A subtypes in Europe: Results from the 2021–2022 I-MOVE primary care multicentre study
2023, Influenza and other Respiratory Viruses
Influenza vaccination coverage and factors associated with severe laboratory-confirmed influenza-related illness in patients receiving care at a tertiary hospital in Catalonia (Spain) during the 2018–2019 epidemic season
2021, PLoS ONE
Age-specific seasonal influenza vaccine effectiveness against different influenza subtypes in the hospitalized population in lithuania during the 2015–2019 influenza seasons
2021, Vaccines

View all citing articles on Scopus

¹: The members of the Primary Health Care Sentinel Network of Navarre are: I Abad, P Aldaz, R Ansorena, I Arcéiz, E Arina, MA Arrechea, I Arribas, N Aznárez, FC Bartolomé, A Beguiristain, A Beltrán, M Bidarte, I Blanco, A Brugos, B Buil, B Cano, MV Castresana, JC Cenoz, F Cia, B Compains, B Churío, PC Cuevas, EM Da Costa, J Díez, FJ Escribano, M Esparza, MJ Esparza, V Etayo, C Fernández Alfaro, B Flamarique, ML Garcés, T García Albéniz, FJ García Nicolás, AB Germán, A Giner, JO Guiu, JC Gurbindo, MJ Guruchaga, JA Heras, M Hernández Galindo, MC Hijos, B Iñigo, MC Irigoyen, JJ Jurio, S Lizarraga, MJ Lizaso, JJ Longás, MJ López, MT Maquirriain, M Mazquiarán, JJ Miner, T Molins, M Moreno, MA Moros, U Navarro, E Orbara, M Orte, M Oscoz, P Palacio, J Palau, C Pérez Lecumberri, P Pérez Pascual, B Pérez Sanz, MJ Plumbed, A Prado, M Prado, A Puig Arrastia, M Ramos, BE Rípodas, M Rodríguez, MA Roncal, I Ruiz Puertas, C Sánchez, F Sánchez Miramón, P Sarrasqueta, F Satrústegui, MA Senosiáin, M Sota, ME Ursua, IA Urtasun, J Villanueva, M Zardoya, ME Zubieta, F Elía, E Albéniz.

²: The members of the Network for Influenza Surveillance in Hospitals of Navarre are: C Beaumont, X Beristain, J Chamorro, C Ezpeleta, F Gallinas, M Herranz, J Hueto, L Moreno, S Martínez-Pérez, A Navascués, ME Portillo, N Viguria, J Sesma (Complejo Hospitalario de Navarra), I Estévez, JJ García Irure, JD Cambra (Hospital Reina Sofía, Tudela), F Lameiro, AI Álvaro, MM Paternain (Hospital García Orcoyen, Estella), I Casado, C Gómez Ibáñez, L Fernandino, J Castilla (Instituto de Salud Pública de Navarra).

View full text

Effectiveness of the current and prior influenza vaccinations in Northern Spain, 2018–2019

Highlights

Abstract

Background

Methods

Results

Conclusion

Introduction

Section snippets

Study design, setting and information sources

Results

Discussion

Conclusions

Funding sources

CRediT authorship contribution statement

Declaration of Competing Interest

Lancet Infect Dis

Vaccine

Vaccine

Vaccine

Vaccine

Vaccine

season estimate of influenza vaccination effectiveness against influenza hospitalisation in children, Hong Kong, winter influenza season 2018/19

Euro Surveill.

Interim estimates of 2018–19 seasonal influenza vaccine effectiveness – United States, February 2019

MMWR Morb Mortal Wkly Rep

Persistence of antibodies to influenza hemagglutinin and neuraminidase following one or two years of influenza vaccination

J Infect Dis

Remaining effect of influenza vaccines received in prior seasons

J Infect Dis

The impact of repeated vaccination on influenza vaccine effectiveness: a systematic review and meta-analysis

BMC Med

Repeated annual influenza vaccination and vaccine effectiveness: review of evidence

Expert Rev Vacc

Combined effectiveness of prior and current season influenza vaccination in northern Spain: 2016/17 mid-season analysis

Euro Surveill

Use of the vaccination register to evaluate influenza vaccine coverage in seniors in the 2010/11 influenza season, Navarre, Spain

Euro Surveill.