Influenza Vaccine Effectiveness and Waning Effect in Hospitalized Older Adults. Valencia Region, Spain, 2018/2019 Season
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Vaccine Information System
2.3. Laboratory Procedures
2.4. Genetic Analysis of Influenza Virus
2.5. Statistical Analysis
2.5.1. IVE Analysis
2.5.2. Waning Effect Analysis
2.5.3. Sensitivity Analysis
3. Results
3.1. Study Subjects and Influenza Season
3.2. Influenza Positives vs. Influenza Negatives
3.3. Vaccinated vs. Unvaccinated Individuals
3.4. A(H1N1)pdm09 Phylogenetic and Mutational Analyses
3.5. A(H3N2) Phylogenetic Analyses and Mutational Profiles
3.6. Vaccine Effectiveness against Overall Influenza and for the Adjuvanted and Non-Adjuvanted Vaccines
3.7. Vaccine Effectiveness against A(H1N1)pdm09 and A(H3N2)
3.8. Overall IVE Waning Effect
3.9. Sensitivity Analysis
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics | Influenza Positives | Influenza Negatives | p-Value | Vaccinated Individuals | Unvaccinated Individuals | p-Value | ||||
---|---|---|---|---|---|---|---|---|---|---|
n | % | n | % | n | % | n | % | |||
Overall | 164 | 100 | 828 | 100 | 662 | 100 | 330 | 100 | ||
Age (median, (IQR)) | 79 | (74–86) | 82 | (75–87) | 0.029 | 81 | (75–87) | 82 | (74–88) | 0.576 |
Age group | 0.171 | 0.782 | ||||||||
65–74 | 49 | 29.88 | 194 | 23.43 | 158 | 23.87 | 85 | 25.76 | ||
75–84 | 61 | 37.20 | 314 | 37.92 | 254 | 38.37 | 121 | 36.67 | ||
≥85 | 54 | 32.93 | 320 | 38.65 | 250 | 37.76 | 124 | 37.58 | ||
Sex | 0.796 | 0.005 | ||||||||
Male | 85 | 51.83 | 420 | 50.72 | 358 | 54.08 | 147 | 44.55 | ||
Female | 79 | 48.17 | 408 | 49.28 | 304 | 45.92 | 183 | 55.45 | ||
Chronic conditions | 0.836 | 0.011 | ||||||||
0 | 9 | 5.49 | 38 | 4.59 | 22 | 3.32 | 25 | 7.58 | ||
1 | 39 | 23.78 | 183 | 22.10 | 143 | 21.60 | 79 | 23.94 | ||
2 | 49 | 29.88 | 239 | 28.86 | 192 | 29.00 | 96 | 29.09 | ||
≥3 | 67 | 40.85 | 368 | 44.44 | 305 | 46.07 | 130 | 39.39 | ||
Pulmonary diseases (other than asthma) | 0.767 | 0.008 | ||||||||
No | 105 | 64.02 | 520 | 62.80 | 398 | 60.12 | 227 | 68.79 | ||
Yes | 59 | 35.98 | 308 | 37.20 | 264 | 39.88 | 103 | 31.21 | ||
Heart diseases | 0.102 | 0.013 | ||||||||
No | 74 | 45.12 | 317 | 38.29 | 243 | 36.71 | 148 | 44.85 | ||
Yes | 90 | 54.88 | 511 | 61.71 | 419 | 63.29 | 182 | 55.15 | ||
Admissions in the previous 12 months | 0.107 | 0.480 | ||||||||
No | 111 | 67.68 | 505 | 60.99 | 406 | 61.33 | 210 | 63.64 | ||
Yes | 53 | 32.32 | 323 | 39.01 | 256 | 38.67 | 120 | 36.36 | ||
GP visits in the previous 3 months | <0.001 | 0.543 | ||||||||
0 | 32 | 19.51 | 79 | 9.54 | 71 | 10.73 | 40 | 12.12 | ||
1 | 21 | 12.80 | 65 | 7.85 | 54 | 8.16 | 32 | 9.70 | ||
≥2 | 111 | 67.68 | 684 | 82.61 | 537 | 81.12 | 258 | 78.18 | ||
Smoking habits | 0.837 | 0.165 | ||||||||
Never smoker | 95 | 57.93 | 498 | 60.14 | 383 | 57.85 | 210 | 63.64 | ||
Ex-smoker | 57 | 34.76 | 277 | 33.45 | 231 | 34.89 | 103 | 31.21 | ||
Current smoker | 12 | 7.32 | 53 | 6.40 | 48 | 7.25 | 17 | 5.15 | ||
Socioeconomic class (occupation) | 0.230 | 0.701 | ||||||||
Professional | 23 | 14.02 | 143 | 17.27 | 107 | 16.16 | 59 | 17.88 | ||
Skilled | 6 | 3.66 | 51 | 6.16 | 40 | 6.04 | 17 | 5.15 | ||
Unskilled | 135 | 82.32 | 634 | 76.57 | 515 | 77.79 | 254 | 76.97 | ||
Obesity | 0.764 | 0.098 | ||||||||
No | 117 | 71.34 | 581 | 70.17 | 477 | 72.05 | 221 | 66.97 | ||
Yes | 47 | 28.66 | 247 | 29.83 | 185 | 27.95 | 109 | 33.03 | ||
Days from onset to swabbing | 0.18 | 0.915 | ||||||||
1–2 | 33 | 20.12 | 194 | 23.43 | 153 | 23.11 | 74 | 22.42 | ||
3–4 | 82 | 50.00 | 349 | 42.15 | 289 | 43.66 | 142 | 43.03 | ||
5–7 | 49 | 29.88 | 285 | 34.42 | 220 | 33.23 | 114 | 34.55 | ||
Functional impairment status (Barthel Index) | 0.117 | 0.595 | ||||||||
Total-severe (0–30) | 18 | 10.98 | 153 | 18.48 | 111 | 16.77 | 60 | 18.18 | ||
Moderate (35–65) | 17 | 10.37 | 76 | 9.18 | 66 | 9.97 | 27 | 8.18 | ||
Mild (70–90) | 31 | 18.90 | 128 | 15.46 | 101 | 15.26 | 58 | 17.58 | ||
Minimal (95–100) | 98 | 59.76 | 471 | 56.88 | 384 | 58.01 | 185 | 56.06 | ||
Vaccination status | 0.015 | NA | ||||||||
No | 68 | 41.46 | 262 | 31.64 | NA | NA | NA | NA | ||
Yes | 96 | 58.54 | 566 | 68.36 | NA | NA | NA | NA | ||
Previous vaccinations (2 seasons) | 0.742 | <0.001 | ||||||||
No | 43 | 26.22 | 207 | 25.00 | 54 | 8.16 | 196 | 59.39 | ||
Yes | 121 | 73.78 | 621 | 75.00 | 608 | 91.84 | 134 | 40.61 | ||
Positives for influenza | NA | |||||||||
A(H1N1)pdm09 | 46 | 28.05 | NA | NA | 21 | 3.17 | 25 | 7.58 | 0.002 | |
A(H3N2) | 116 | 70.73 | NA | NA | 73 | 11.03 | 43 | 13.03 | 0.355 | |
A not subtyped | 2 | 1.22 | NA | NA | 2 | 0.30 | 0 | 0.00 | 0.318 |
IVE Estimates | Cases | Controls | IVE (%) | 95% CI | ||||||
---|---|---|---|---|---|---|---|---|---|---|
Vaccinated | Unvaccinated | Vaccinated | Unvaccinated | |||||||
N | % | N | % | N | % | N | % | |||
1. IVE against overall influenza a | 96 | 58.54 | 68 | 41.46 | 566 | 68.36 | 262 | 31.64 | 46.53 | (16.49, 65.77) |
2. IVE against A(H1N1)pdm09 a | 21 | 45.65 | 25 | 54.35 | 330 | 67.90 | 156 | 32.10 | 40.65 | (−33.84, 73.68) |
3. IVE against A(H3N2) a | 73 | 62.93 | 43 | 37.07 | 566 | 68.36 | 262 | 31.64 | 44.90 | (7.40, 67.21) |
4. MF59-adjuvanted (in ≥75 years old) IVE against overall influenza a | 44 | 50.57 | 43 | 49.43 | 261 | 56.37 | 202 | 43.63 | 44.81 | (2.03, 68.91) |
5. Non-adjuvanted (in 65–74 years old) IVE against overall influenza | 20 | 46.51 | 23 | 53.49 | 83 | 63.36 | 48 | 36.64 | 59.50 | (−16.33, 85.90) |
6. IVE against overall influenza according to days between vaccination and symptoms’ onset dates b: | ||||||||||
Not vaccinated | NA | NA | 68 | 100 | NA | NA | 262 | 100 | Ref. | |
15–82 days | 21 | 21.88 | NA | NA | 191 | 33.75 | NA | NA | 54.17 | (12.51, 75.99) |
83–122 days | 55 | 57.29 | NA | NA | 167 | 29.51 | NA | NA | 35.66 | (−9.33, 62.14) |
123–177 days | 19 | 19.79 | NA | NA | 196 | 34.63 | NA | NA | 49.83 | (−2.77, 75.51) |
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Mira-Iglesias, A.; López-Labrador, F.X.; García-Rubio, J.; Mengual-Chuliá, B.; Tortajada-Girbés, M.; Mollar-Maseres, J.; Carballido-Fernández, M.; Schwarz-Chavarri, G.; Puig-Barberà, J.; Díez-Domingo, J. Influenza Vaccine Effectiveness and Waning Effect in Hospitalized Older Adults. Valencia Region, Spain, 2018/2019 Season. Int. J. Environ. Res. Public Health 2021, 18, 1129. https://doi.org/10.3390/ijerph18031129
Mira-Iglesias A, López-Labrador FX, García-Rubio J, Mengual-Chuliá B, Tortajada-Girbés M, Mollar-Maseres J, Carballido-Fernández M, Schwarz-Chavarri G, Puig-Barberà J, Díez-Domingo J. Influenza Vaccine Effectiveness and Waning Effect in Hospitalized Older Adults. Valencia Region, Spain, 2018/2019 Season. International Journal of Environmental Research and Public Health. 2021; 18(3):1129. https://doi.org/10.3390/ijerph18031129
Chicago/Turabian StyleMira-Iglesias, Ainara, F. Xavier López-Labrador, Javier García-Rubio, Beatriz Mengual-Chuliá, Miguel Tortajada-Girbés, Joan Mollar-Maseres, Mario Carballido-Fernández, Germán Schwarz-Chavarri, Joan Puig-Barberà, and Javier Díez-Domingo. 2021. "Influenza Vaccine Effectiveness and Waning Effect in Hospitalized Older Adults. Valencia Region, Spain, 2018/2019 Season" International Journal of Environmental Research and Public Health 18, no. 3: 1129. https://doi.org/10.3390/ijerph18031129