A Perfect Storm: Impact of Genomic Variation and Serial Vaccination on Low Influenza Vaccine Effectiveness During the 2014–2015 Season

Skowronski, Danuta M.; Chambers, Catharine; Sabaiduc, Suzana; Serres, Gaston De; Winter, Anne-Luise; Dickinson, James A; Krajden, Mel; Gubbay, Jonathan B.; Drews, Steven J.; Martineau, Christine; Eshaghi, Alireza; Kwindt, Trijntje L.; Bastien, Nathalie; Li, Yan

doi:10.1093/cid/ciw176

Cited by 186 publications

(195 citation statements)

References 39 publications

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“…Conversely, the observation of no residual protection from prior season vaccination was more consistent, with lower heterogeneity (I 2 = 48%, p = .1). Of note, two of three studies reported pronounced difference between repeated versus current season only vaccination during the 2014-2015 season [28,30], and this difference was statistically significant in one study [28]. Vaccine strains were unchanged and there was well-recognized mismatch between vaccine and epidemic strains, a pattern consistent with the antigenic distance hypothesis.…”

Section: H3n2mentioning

confidence: 69%

“…Eighteen studies met the eligibility criteria [4,13,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Of these, one study was restricted to hospitalized patients and was therefore excluded from the meta-analysis [31].…”

Section: Resultsmentioning

confidence: 99%

“…An additional study assessed the impact of prior vaccination in one and/or two seasons on vaccine effectiveness against H3N2 during the 2014-2015 season in Canada [28]. In this study, patients were enrolled by sentinel physicians, and current and prior vaccinations were determined by physician records and/or self-report.…”

Section: Ve Studies Of Repeated Vaccination In Multiple Prior Seasonsmentioning

confidence: 99%

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Repeated annual influenza vaccination and vaccine effectiveness: review of evidence

Belongia

Skowronski

McLean

et al. 2017

Expert Review of Vaccines

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239

185

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Introduction: Studies in the 1970s and 1980s signaled concern that repeated influenza vaccination could affect vaccine protection. The antigenic distance hypothesis provided a theoretical framework to explain variability in repeat vaccination effects based on antigenic similarity between successive vaccine components and the epidemic strain. Areas covered: A meta-analysis of vaccine effectiveness studies from 2010-11 through 2014-15 shows substantial heterogeneity in repeat vaccination effects within and between seasons and subtypes. When negative effects were observed, they were most pronounced for H3N2, especially in 2014-15 when vaccine components were unchanged and antigenically distinct from the epidemic strain. Studies of repeated vaccination across multiple seasons suggest that vaccine effectiveness may be influenced by more than one prior season. In immunogenicity studies, repeated vaccination blunts the hemagglutinin antibody response, particularly for H3N2. Expert commentary: Substantial heterogeneity in repeated vaccination effects is not surprising given the variation in study populations and seasons, and the variable effects of antigenic distance and immunological landscape in different age groups and populations. Caution is required in the interpretation of pooled results across multiple seasons, since this can mask important variation in repeat vaccination effects between seasons. Multi-season clinical studies are needed to understand repeat vaccination effects and guide recommendations. ARTICLE HISTORY

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Section: H3n2mentioning

confidence: 69%

Section: Resultsmentioning

confidence: 99%

Section: Ve Studies Of Repeated Vaccination In Multiple Prior Seasonsmentioning

confidence: 99%

See 1 more Smart Citation

Repeated annual influenza vaccination and vaccine effectiveness: review of evidence

Belongia

Skowronski

McLean

et al. 2017

Expert Review of Vaccines

Self Cite

239

185

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show abstract

“…In the 2013-2014 season, LAIV VE against A/H1N1pdm2009 [3] (A/H1N1) was poor. Furthermore, the 2014-2015 season was characterized by the emergence of an A/H3N2 drifted virus that was associated with low VE in an early season estimate [4,5], and with an earlier-than-normal peak in influenza cases occurring in late December [6]. Thus, the unpredictability of influenza epidemiology continues to necessitate effectiveness studies of available influenza vaccines in a range of population subgroups.…”

mentioning

confidence: 99%

2014–2015 Influenza Vaccine Effectiveness in the United States by Vaccine Type

et al. 2016

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Background. Circulating A/H3N2 influenza viruses drifted significantly after strain selection for the 2014-2015 vaccines. Also in 2014-2015, the Advisory Committee on Immunization Practices recommended preferential use of live attenuated influenza vaccine (LAIV) over inactivated influenza vaccine (IIV) among children aged 2-8 years.Methods. Vaccine effectiveness (VE) across age groups and vaccine types was examined among outpatients with acute respiratory illness at 5 US sites using a test-negative design, that compared the odds of vaccination among reverse transcription polymerase chain reaction-confirmed influenza positives and negatives.Results. Of 9311 enrollees with complete data, 7078 (76%) were influenza negative, 1840 (19.8%) were positive for influenza A (A/H3N2, n = 1817), and 395 (4.2%) were positive for influenza B (B/Yamagata, n = 340). The overall adjusted VE was 19% (95% confidence interval [CI], 10% to 27%) and was statistically significant in all age strata except those aged 18-64 years. The adjusted VE of 6% (95%CI, −5% to 17%) against A/H3N2-associated illness was not statistically significant, unlike VE for influenza B/Yamagata, which was 55% (95%CI, 43% to 65%). Among those aged 2-8 years, VE against A/H3N2 was 15% (95%CI, −16% to 38%) for IIV and −3% (CI, −50% to 29%) for LAIV; VE against B/Yamagata was 40% (95%CI, −20% to 70%) for IIV and 74% (95%CI, 25% to 91%) for LAIV.Conclusions. The 2014-2015 influenza vaccines offered little protection against the predominant influenza A/H3N2 virus but were effective against influenza B. Preferential use of LAIV among young children was not supported.

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“…For all three seasons combined, a total of 111,580 respiratory specimens were tested for influenza with 16,135 (14.5%) testing positive 41% [14] (95% Confidence Interval, 17%-59%) -16% [9] (95% Confidence Interval, -49%-9%) * Reporting changes during the 2014/2015 influenza season likely resulted in under-reporting of the number of hospitalizations and deaths for that season †While the number of influenza A-positive specimens is based on PHOL data, the number of influenza A cases includes all laboratory-confirmed cases reported through the integrated Public Health Information System (iPHIS) by Ontario's public health units, which includes data from all laboratories in Ontario that test for influenza Figure 1 and Figure 2) ( Table 1).…”

Section: Comparison Of the Severity Of H3n2 Dominant Influenza Seasonsmentioning

confidence: 99%

Describing the magnitude of the 2014/2015 influenza A(H3N2) dominant season; can the slope explain the experience?

Winter¹,

Peci²,

Li³

et al. 2016

Clin Microbiol Infect Dis

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Background: Assessing seasonal severity of influenza is problematic; traditional indicators may not be reliable to determine the magnitude of each influenza season. We investigated why the overall impact of influenza was much higher during the 2014/2015 season despite the fact that peak influenza positivity was lower than both the 2010/2011 and 2012/2013 influenza A(H3N2) dominant influenza seasons. The magnitudes of area under the epidemic curve of influenza positivity and the ascending and descending slopes as a measure of seasonal severity were also explored.

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A Perfect Storm: Impact of Genomic Variation and Serial Vaccination on Low Influenza Vaccine Effectiveness During the 2014–2015 Season

Cited by 186 publications

References 39 publications

Repeated annual influenza vaccination and vaccine effectiveness: review of evidence

Repeated annual influenza vaccination and vaccine effectiveness: review of evidence

2014–2015 Influenza Vaccine Effectiveness in the United States by Vaccine Type

Describing the magnitude of the 2014/2015 influenza A(H3N2) dominant season; can the slope explain the experience?

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