Suboptimal Effectiveness of the 2011–2012 Seasonal Influenza Vaccine in Adult Korean Populations

Choi, Won Suk; Noh, Ji Yun; Baek, Ji Hyeon; Seo, Yu Bin; Jacob, Louis; Song, Joon Young; Park, Dae Won; Lee, Jin Soo; Cheong, Hee Jin

doi:10.1371/journal.pone.0098716

Cited by 10 publications

(8 citation statements)

References 22 publications

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“…Based on these, vaccine effectiveness against H3N2 might be assumed so poor that the increases of ILI incidence rates appeared to be unavoidable during the 2011/12 season. Consistent with this observation, several reports of reduced vaccine effectiveness against the H3N2 virus have been reported from Asia, Europe, and North America [54–56] and even from Korea [15]. As demonstrated by the positive correlation between the ILI incidence rates and the number of H3N2 isolates (Fig 1 and S2 Table), the phylogenetic clustering patterns of the HA and NA genes might substantiate its significance with regard to the comprehensive process of vaccine virus selection.…”

Section: Discussionsupporting

confidence: 80%

Phylogenetic relationships of the HA and NA genes between vaccine and seasonal influenza A(H3N2) strains in Korea

et al. 2017

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Seasonal influenza is caused by two influenza A subtype (H1N1 and H3N2) and two influenza B lineage (Victoria and Yamagata) viruses. Of these antigenically distinct viruses, the H3N2 virus was consistently detected in substantial proportions in Korea during the 2010/11-2013/14 seasons when compared to the other viruses and appeared responsible for the influenza-like illness rate peak during the first half of the 2011/12 season. To further scrutinize possible causes for this, we investigated the evolutionary and serological relationships between the vaccine and Korean H3N2 strains during the 2011/12 season for the main antigenic determinants of influenza viruses, the hemagglutinin (HA) and neuraminidase (NA) genes. In the 2011/12 season, when the number of H3N2 cases peaked, the majority of the Korean strains did not belong to the HA clade of A/Perth/16/2009 vaccine, and no Korean strains were of this lineage in the NA segment. In a serological assay, post-vaccinated human sera exhibited much reduced hemagglutination inhibition antibody titers against the non-vaccine clade Korean H3N2 strains. Moreover, Korean strains harbored several amino acid differences in the HA antigenic sites and in the NA with respect to vaccine lineages during this season. Of these, the HA antigenic site C residues 45 and 261 and the NA residue 81 appeared to be the signatures of positive selection. In subsequent seasons, when H3N2 cases were lower, the HA and NA genes of vaccine and Korean strains were more phylogenetically related to each other. Combined, our results provide indirect support for using phylogenetic clustering patterns of the HA and possibly also the NA genes in the selection of vaccine viruses and the assessment of vaccine effectiveness.

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Section: Discussionsupporting

confidence: 80%

Phylogenetic relationships of the HA and NA genes between vaccine and seasonal influenza A(H3N2) strains in Korea

et al. 2017

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“…Recently, the Spanish influenza surveillance system reported low VE in seasons with predominant circulation of influenza A/H3N2 (14). Similarly, in the ROK, circulation of influenza A/H3N2 was dominant in the past 3 years, with reportedly low influenza VE (15,16). Of note, this study showed that influenza vaccination would be beneficial for elderly individuals and those with comorbidities despite statistically insignificant influenza VE.…”

Section: Discussionmentioning

confidence: 56%

Prospective Cohort Study on the Effectiveness of Influenza and Pneumococcal Vaccines in Preventing Pneumonia Development and Hospitalization

Song

Lee

Wie

et al. 2014

Clin. Vaccine Immunol.

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j Pneumonia and acute exacerbation of chronic illness are leading causes of influenza-related hospitalization. Therefore, influenza and pneumococcal vaccinations are strongly recommended for adults with comorbidities. Using a hospital-based influenza surveillance system, we performed a multicenter, prospective cohort study of patients visiting emergency rooms with influenza-like illness (ILI) during the influenza epidemic period in 2013 to 2014. Patients aged >19 years were enrolled, and clinical data were collected. Multivariate analyses were performed to estimate the effectiveness of influenza and pneumococcal vaccination in preventing pneumonia development and hospitalization. During study periods, 2,262 patients with ILI were registered. Among 2,217 patients with available vaccination records, 31.9% (707 patients) and 9.7% (216 patients) had received influenza and pneumococcal vaccines, respectively. Among patients who had been administered a pneumococcal vaccine, 94.4% had received the 23-valent polysaccharide vaccine (PPV23). The adjusted rates of effectiveness of the influenza vaccine for preventing pneumonia development and hospitalization were 64.0% (95% confidence interval [CI] ‫؍‬ 29% to 81%) and 35.0% (95% CI ‫؍‬ 12% to 52%), respectively. Pneumococcal vaccination did not reduce pneumonia development or hospitalization. In conclusion, influenza rather than PPV23 vaccination may reduce pneumonia development and hospitalization in patients with preceding ILI.

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“…Due to the limited number of TND studies reporting very severe outcomes, 45,52,88 we could not compute pooled IVE against ICU admission associated with laboratory confirmed influenza. Castilla et al 88 reported a higher IVE against ICU compared to hospitalized influenza and concluded that vaccination lowered the severity of hospitalized cases of influenza.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of influenza vaccines in preventing severe influenza illness among adults: A systematic review and meta-analysis of test-negative design case-control studies

Rondy

Omeiri

Thompson

et al. 2017

Journal of Infection

188

128

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Summary Objectives Summary evidence of influenza vaccine effectiveness (IVE) against hospitalized influenza is lacking. We conducted a meta-analysis of studies reporting IVE against laboratory-confirmed hospitalized influenza among adults. Methods We searched Pubmed (January 2009 to November 2016) for studies that used test-negative design (TND) to enrol patients hospitalized with influenza-associated conditions. Two independent authors selected relevant articles. We calculated pooled IVE against any and (sub)type specific influenza among all adults, and stratified by age group (18–64 and 65 years and above) using random-effects models. Results We identified 3411 publications and 30 met our inclusion criteria. Between 2010–11 and 2014–15, the pooled seasonal IVE was 41% (95%CI:34;48) for any influenza (51% (95%CI:44;58) among people aged 18–64y and 37% (95%CI:30;44) among ≥65 years). IVE was 48% (95%CI:37;59), 37% (95%CI:24;50) and 38% (95%CI:23;53) against influenza A(H1N1)pdm09, A(H3N2) and B, respectively. Among persons aged ≥65 year, IVE against A(H3N2) was 43% (95%CI:33;53) in seasons when circulating and vaccine strains were antigenically similar and 14% (95%CI: −3;30) when A(H3N2) variant viruses predominated. Conclusions Influenza vaccines provided moderate protection against influenza-associated hospitalizations among adults. They seemed to provide low protection among elderly in seasons where vaccine and circulating A(H3N2) strains were antigenically variant.

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Suboptimal Effectiveness of the 2011–2012 Seasonal Influenza Vaccine in Adult Korean Populations

Cited by 10 publications

References 22 publications

Phylogenetic relationships of the HA and NA genes between vaccine and seasonal influenza A(H3N2) strains in Korea

Phylogenetic relationships of the HA and NA genes between vaccine and seasonal influenza A(H3N2) strains in Korea

Prospective Cohort Study on the Effectiveness of Influenza and Pneumococcal Vaccines in Preventing Pneumonia Development and Hospitalization

Effectiveness of influenza vaccines in preventing severe influenza illness among adults: A systematic review and meta-analysis of test-negative design case-control studies

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