Effectiveness of the current and prior influenza vaccinations in Northern Spain, 2018–2019
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 MedicineCitation 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.
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, VaccineCitation 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].
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
- 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).