Seasonal Influenza Vaccine Effectiveness in People With Asthma: A National Test-Negative Design Case-Control Study

Eleftheria Vasileiou; Aziz Sheikh; Chris C Butler; Chris Robertson; Kimberley Kavanagh; Tanya Englishby; Nazir I Lone; Beatrix von Wissmann; Jim McMenamin; Lewis D Ritchie; Jürgen Schwarze; Rory Gunson; Colin R Simpson

doi:10.1093/cid/ciz1086

Seasonal Influenza Vaccine Effectiveness in People With Asthma: A National Test-Negative Design Case-Control Study

Eleftheria Vasileiou^* (Corresponding Author), Aziz Sheikh, Chris C Butler, Chris Robertson, Kimberley Kavanagh, Tanya Englishby, Nazir I Lone, Beatrix von Wissmann, Jim McMenamin, Lewis D Ritchie, Jürgen Schwarze, Rory Gunson, Colin R Simpson

^*Corresponding author for this work

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Abstract

BACKGROUND: Influenza infection is an important trigger of asthma attacks. Influenza vaccination has the potential to reduce the incidence of influenza in people with asthma, but uptake remains persistently low, partially reflecting concerns about vaccine effectiveness (VE).

METHODS: We conducted a test-negative design case-control study to estimate the effectiveness of influenza vaccine in children and adults with asthma in Scotland over six influenza seasons (2010/11 to 2015/16). We used individual patient level data from 223 primary care practices which yielded 1,830,772 patient-years of data, which were linked with hospital and virological (n=5,910 swabs) data.

RESULTS: Vaccination was associated with an overall 55.0% (95% confidence interval (CI): 45.8-62.7) reduction in the risk of a laboratory-confirmed influenza infection in people with asthma over the six seasons. There was substantial variation in VE between seasons, influenza strains and age groups. The highest VE (76.1%; 95% CI: 55.6-87.1) was found in 2010/11 season where the A(H1N1) strain dominated and there was a good antigenic vaccine match. High protection was observed against A(H1N1) (e.g. 2010/11: 70.7%; 95%CI: 32.5-87.3) and B strains (e.g. 2010/11: 83.2%; 95%CI: 44.3-94.9), but there was lower protection for the A(H3N2) strain (e.g. 2014/15: 26.4%; 95%CI: -12.0-51.6). The highest VE against all viral strains was observed in adults aged 18-54 years (57.0%; 95%CI: 42.3-68.0).

CONCLUSION: Influenza vaccination gave meaningful protection against laboratory-confirmed influenza in people asthma across all six seasons. Strategies to boost influenza vaccine uptake has the potential to substantially reduce influenza triggered asthma attacks.

Original language	English
Pages (from-to)	e94-e104
Number of pages	11
Journal	Clinical Infectious Diseases
Volume	71
Issue number	7
Early online date	5 Nov 2019
DOIs	https://doi.org/10.1093/cid/ciz1086
Publication status	Published - 1 Oct 2020

Bibliographical note

Financial support. The work was funded by the Chief Scientist Office of the Scottish Government under the grant (AUKCAR/14/03) and the NIHR–Health Technology Assessment (HTA) Programme (13/34/14) for the Seasonal Influenza Vaccination Effectiveness II (SIVE II) study. As principal investigator, C. R. S. received a grant for the SIVE-II project from the NIHR HTA. This work was carried out with the support of the Asthma UK Centre for Applied Research (AUK-AC-2012-01), the Farr Institute (MR/M501633/2), Health Data Research UK (an initiative funded by UK Research and Innovation, Department of Health and Social Care England and the devolved administrations and leading medical research charities), the European Union’s Horizon 2020 research and innovation programme (under grant agreement No 634446) and European Centre for Disease Prevention and Control (Influenza-Monitoring Vaccine Effectiveness).

Acknowledgments. The authors thank and acknowledge all colleagues at the Asthma UK Centre for Applied Research for their support in this study.

Disclaimer. The funding bodies had no role in the design of the study, review process, analysis, interpretation, or reporting of data. The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the Health Technology Assessment Programme, National Institute for Health Research (NIHR), National Health Service, or the Department of Health.

Potential conflicts of interest. The authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Keywords

influenza
vaccination
asthma
laboratory-confirmed influenza
Laboratory-confirmed influenza
Influenza
Vaccination
Asthma

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Clinical Infectious Diseases® 2019;XX(XX):1–11 © The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
Final published version, 565 KBLicence: CC BY-NC-ND
Vasileiou_et_al_Seasonal_Influenza_Clinical_Infectious_Diseases_vor
Clinical Infectious Diseases® 2020;71(7):e94–e104 © The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com DOI: 10.1093/cid/ciz1086
Final published version, 970 KBLicence: CC BY-ND

Cite this

Vasileiou, E., Sheikh, A., Butler, C. C., Robertson, C., Kavanagh, K., Englishby, T., Lone, N. I., von Wissmann, B., McMenamin, J., Ritchie, L. D., Schwarze, J., Gunson, R., & Simpson, C. R. (2020). Seasonal Influenza Vaccine Effectiveness in People With Asthma: A National Test-Negative Design Case-Control Study . Clinical Infectious Diseases, 71(7), e94-e104. https://doi.org/10.1093/cid/ciz1086

Vasileiou, E, Sheikh, A, Butler, CC, Robertson, C, Kavanagh, K, Englishby, T, Lone, NI, von Wissmann, B, McMenamin, J, Ritchie, LD, Schwarze, J, Gunson, R & Simpson, CR 2020, 'Seasonal Influenza Vaccine Effectiveness in People With Asthma: A National Test-Negative Design Case-Control Study ', Clinical Infectious Diseases, vol. 71, no. 7, pp. e94-e104. https://doi.org/10.1093/cid/ciz1086

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title = "Seasonal Influenza Vaccine Effectiveness in People With Asthma: A National Test-Negative Design Case-Control Study ",

abstract = "BACKGROUND: Influenza infection is an important trigger of asthma attacks. Influenza vaccination has the potential to reduce the incidence of influenza in people with asthma, but uptake remains persistently low, partially reflecting concerns about vaccine effectiveness (VE).METHODS: We conducted a test-negative design case-control study to estimate the effectiveness of influenza vaccine in children and adults with asthma in Scotland over six influenza seasons (2010/11 to 2015/16). We used individual patient level data from 223 primary care practices which yielded 1,830,772 patient-years of data, which were linked with hospital and virological (n=5,910 swabs) data.RESULTS: Vaccination was associated with an overall 55.0% (95% confidence interval (CI): 45.8-62.7) reduction in the risk of a laboratory-confirmed influenza infection in people with asthma over the six seasons. There was substantial variation in VE between seasons, influenza strains and age groups. The highest VE (76.1%; 95% CI: 55.6-87.1) was found in 2010/11 season where the A(H1N1) strain dominated and there was a good antigenic vaccine match. High protection was observed against A(H1N1) (e.g. 2010/11: 70.7%; 95%CI: 32.5-87.3) and B strains (e.g. 2010/11: 83.2%; 95%CI: 44.3-94.9), but there was lower protection for the A(H3N2) strain (e.g. 2014/15: 26.4%; 95%CI: -12.0-51.6). The highest VE against all viral strains was observed in adults aged 18-54 years (57.0%; 95%CI: 42.3-68.0).CONCLUSION: Influenza vaccination gave meaningful protection against laboratory-confirmed influenza in people asthma across all six seasons. Strategies to boost influenza vaccine uptake has the potential to substantially reduce influenza triggered asthma attacks.",

keywords = "influenza, vaccination, asthma, laboratory-confirmed influenza, Laboratory-confirmed influenza, Influenza, Vaccination, Asthma",

author = "Eleftheria Vasileiou and Aziz Sheikh and Butler, {Chris C} and Chris Robertson and Kimberley Kavanagh and Tanya Englishby and Lone, {Nazir I} and {von Wissmann}, Beatrix and Jim McMenamin and Ritchie, {Lewis D} and J{\"u}rgen Schwarze and Rory Gunson and Simpson, {Colin R}",

note = "Financial support. The work was funded by the Chief Scientist Office of the Scottish Government under the grant (AUKCAR/14/03) and the NIHR–Health Technology Assessment (HTA) Programme (13/34/14) for the Seasonal Influenza Vaccination Effectiveness II (SIVE II) study. As principal investigator, C. R. S. received a grant for the SIVE-II project from the NIHR HTA. This work was carried out with the support of the Asthma UK Centre for Applied Research (AUK-AC-2012-01), the Farr Institute (MR/M501633/2), Health Data Research UK (an initiative funded by UK Research and Innovation, Department of Health and Social Care England and the devolved administrations and leading medical research charities), the European Union{\textquoteright}s Horizon 2020 research and innovation programme (under grant agreement No 634446) and European Centre for Disease Prevention and Control (Influenza-Monitoring Vaccine Effectiveness). Acknowledgments. The authors thank and acknowledge all colleagues at the Asthma UK Centre for Applied Research for their support in this study. Disclaimer. The funding bodies had no role in the design of the study, review process, analysis, interpretation, or reporting of data. The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the Health Technology Assessment Programme, National Institute for Health Research (NIHR), National Health Service, or the Department of Health. Potential conflicts of interest. The authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. ",

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T1 - Seasonal Influenza Vaccine Effectiveness in People With Asthma

T2 - A National Test-Negative Design Case-Control Study

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AU - Sheikh, Aziz

AU - Butler, Chris C

AU - Robertson, Chris

AU - Kavanagh, Kimberley

AU - Englishby, Tanya

AU - Lone, Nazir I

AU - von Wissmann, Beatrix

AU - McMenamin, Jim

AU - Ritchie, Lewis D

AU - Schwarze, Jürgen

AU - Gunson, Rory

AU - Simpson, Colin R

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PY - 2020/10/1

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N2 - BACKGROUND: Influenza infection is an important trigger of asthma attacks. Influenza vaccination has the potential to reduce the incidence of influenza in people with asthma, but uptake remains persistently low, partially reflecting concerns about vaccine effectiveness (VE).METHODS: We conducted a test-negative design case-control study to estimate the effectiveness of influenza vaccine in children and adults with asthma in Scotland over six influenza seasons (2010/11 to 2015/16). We used individual patient level data from 223 primary care practices which yielded 1,830,772 patient-years of data, which were linked with hospital and virological (n=5,910 swabs) data.RESULTS: Vaccination was associated with an overall 55.0% (95% confidence interval (CI): 45.8-62.7) reduction in the risk of a laboratory-confirmed influenza infection in people with asthma over the six seasons. There was substantial variation in VE between seasons, influenza strains and age groups. The highest VE (76.1%; 95% CI: 55.6-87.1) was found in 2010/11 season where the A(H1N1) strain dominated and there was a good antigenic vaccine match. High protection was observed against A(H1N1) (e.g. 2010/11: 70.7%; 95%CI: 32.5-87.3) and B strains (e.g. 2010/11: 83.2%; 95%CI: 44.3-94.9), but there was lower protection for the A(H3N2) strain (e.g. 2014/15: 26.4%; 95%CI: -12.0-51.6). The highest VE against all viral strains was observed in adults aged 18-54 years (57.0%; 95%CI: 42.3-68.0).CONCLUSION: Influenza vaccination gave meaningful protection against laboratory-confirmed influenza in people asthma across all six seasons. Strategies to boost influenza vaccine uptake has the potential to substantially reduce influenza triggered asthma attacks.

AB - BACKGROUND: Influenza infection is an important trigger of asthma attacks. Influenza vaccination has the potential to reduce the incidence of influenza in people with asthma, but uptake remains persistently low, partially reflecting concerns about vaccine effectiveness (VE).METHODS: We conducted a test-negative design case-control study to estimate the effectiveness of influenza vaccine in children and adults with asthma in Scotland over six influenza seasons (2010/11 to 2015/16). We used individual patient level data from 223 primary care practices which yielded 1,830,772 patient-years of data, which were linked with hospital and virological (n=5,910 swabs) data.RESULTS: Vaccination was associated with an overall 55.0% (95% confidence interval (CI): 45.8-62.7) reduction in the risk of a laboratory-confirmed influenza infection in people with asthma over the six seasons. There was substantial variation in VE between seasons, influenza strains and age groups. The highest VE (76.1%; 95% CI: 55.6-87.1) was found in 2010/11 season where the A(H1N1) strain dominated and there was a good antigenic vaccine match. High protection was observed against A(H1N1) (e.g. 2010/11: 70.7%; 95%CI: 32.5-87.3) and B strains (e.g. 2010/11: 83.2%; 95%CI: 44.3-94.9), but there was lower protection for the A(H3N2) strain (e.g. 2014/15: 26.4%; 95%CI: -12.0-51.6). The highest VE against all viral strains was observed in adults aged 18-54 years (57.0%; 95%CI: 42.3-68.0).CONCLUSION: Influenza vaccination gave meaningful protection against laboratory-confirmed influenza in people asthma across all six seasons. Strategies to boost influenza vaccine uptake has the potential to substantially reduce influenza triggered asthma attacks.

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Seasonal Influenza Vaccine Effectiveness in People With Asthma: A National Test-Negative Design Case-Control Study

Abstract

Bibliographical note

Keywords

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Lewis Ritchie, OBE

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Seasonal Influenza Vaccine Effectiveness in People With Asthma: A National Test-Negative Design Case-Control Study

Abstract

Bibliographical note

Keywords

UN SDGs

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Fingerprint

Profiles

Lewis Ritchie, OBE

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