Effectiveness of influenza vaccine against influenza A in Europe in seasons of different A(H1N1)pdm09 and the same A(H3N2) vaccine components (2016–17 and 2017–18)
Esther Kissling,
Francisco Pozo,
Silke Buda,
Ana-Maria Vilcu,
Caterina Rizzo,
Alin Gherasim,
Judit Krisztina Horváth,
Mia Brytting,
Lisa Domegan,
Adam Meijer,
Iwona Paradowska-Stankiewicz,
Ausenda Machado,
Vesna Višekruna Vučina,
Mihaela Lazar,
Kari Johansen,
Ralf Dürrwald,
Sylvie van der Werf,
Antonino Bella,
Amparo Larrauri,
Annamária Ferenczi,
Katherina Zakikhany,
Joan O'Donnell,
Frederika Dijkstra,
Joanna Bogusz,
Raquel Guiomar,
Sanja Kurečić Filipović,
Daniela Pitigoi,
Pasi Penttinen,
Marta Valenciano
Affiliations
Esther Kissling
Epidemiology Department, Epiconcept, 47 rue de Charenton, 75012 Paris, France; Corresponding author at: Esther Kissling, Epiconcept, 47 rue de Charenton, 75012 Paris, France.
Francisco Pozo
National Centre for Microbiology, National Influenza Reference Laboratory, WHO-National Influenza Centre, Institute of Health Carlos III, Madrid, Spain
Silke Buda
Robert Koch Institute, Department of Infectious Disease Epidemiology, Respiratory Infections Unit, Seestrasse 10, 13353 Berlin, Germany
Ana-Maria Vilcu
Sorbonne Université, INSERM, Institut Pierre Louis d’épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75012, Paris, France
Caterina Rizzo
Department of Infectious Diseases, National Institute of Health, Rome, Italy; Bambino Gesù Children’s Hospital, Rome, Italy
Alin Gherasim
National Epidemiology Centre, Institute of Health Carlos III, Madrid, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid Spain
Judit Krisztina Horváth
Office of the Chief Medical Officer, Budapest, Hungary
Mia Brytting
Public Health Agency of Sweden, Stockholm, Sweden
Lisa Domegan
Health Service Executive-Health Protection Surveillance Centre, 25-27 Middle Gardiner Street, Dublin 1 D01 A4A3, Ireland
Adam Meijer
National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
Iwona Paradowska-Stankiewicz
National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
Ausenda Machado
Departamento de Epidemiologia, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
Vesna Višekruna Vučina
Croatian Institute of Public Health, Zagreb, Croatia
Mihaela Lazar
“Cantacuzino” National Medico-Military Institute for Research and Development, Bucharest, Romania
Kari Johansen
European Centre for Disease Prevention and Control (ECDC), Gustav III:s boulevard 40, 169 73 Solna, Sweden
Ralf Dürrwald
Robert Koch Institute, National Reference Center for Influenza, Seestrasse 10, 13353 Berlin, Germany
Sylvie van der Werf
Unité de Génétique Moléculaire des Virus à ARN, Institut Pasteur, CNRS UMR3569, Université Paris Diderot SPC, France; CNR des Virus des Infections Respiratoires, WHO National Influenza Center, Institut Pasteur, France
Antonino Bella
Department of Infectious Diseases, National Institute of Health, Rome, Italy
Amparo Larrauri
National Epidemiology Centre, Institute of Health Carlos III, Madrid, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid Spain
Annamária Ferenczi
Office of the Chief Medical Officer, Budapest, Hungary
Katherina Zakikhany
Public Health Agency of Sweden, Stockholm, Sweden
Joan O'Donnell
Health Service Executive-Health Protection Surveillance Centre, 25-27 Middle Gardiner Street, Dublin 1 D01 A4A3, Ireland
Frederika Dijkstra
National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
Joanna Bogusz
National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
Raquel Guiomar
Departamento de Doenças Infeciosas, Instituto Nacional de Saúde Dr. Ricardo Jorge, Portugal
Sanja Kurečić Filipović
Croatian Institute of Public Health, Zagreb, Croatia
Daniela Pitigoi
Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Pasi Penttinen
European Centre for Disease Prevention and Control (ECDC), Gustav III:s boulevard 40, 169 73 Solna, Sweden
Marta Valenciano
Epidemiology Department, Epiconcept, 47 rue de Charenton, 75012 Paris, France
Introduction: Influenza A(H3N2) viruses predominated in Europe in 2016–17. In 2017–18 A(H3N2) and A(H1N1)pdm09 viruses co-circulated. The A(H3N2) vaccine component was the same in both seasons; while the A(H1N1)pdm09 component changed in 2017–18. In both seasons, vaccine seed A(H3N2) viruses developed adaptations/alterations during propagation in eggs, impacting antigenicity. Methods: We used the test-negative design in a multicentre primary care case-control study in 12 European countries to measure 2016–17 and 2017–18 influenza vaccine effectiveness (VE) against laboratory-confirmed influenza A(H1N1)pdm09 and A(H3N2) overall and by age group. Results: During the 2017–18 season, the overall VE against influenza A(H1N1)pdm09 was 59% (95% CI: 47–69). Among those aged 0–14, 15–64 and ≥65 years, VE against A(H1N1)pdm09 was 64% (95% CI: 37–79), 50% (95% CI: 28–66) and 66% (95% CI: 42–80), respectively. Overall VE against influenza A(H3N2) was 28% (95% CI: 17–38) in 2016–17 and 13% (95% CI: −15 to 34) in 2017–18. Among 0–14-year-olds VE against A(H3N2) was 28% (95%CI: −10 to 53) and 29% (95% CI: −87 to 73), among 15–64-year-olds 34% (95% CI: 18–46) and 33% (95% CI: −3 to 56) and among those aged ≥65 years 15% (95% CI: −10 to 34) and −9% (95% CI: −74 to 32) in 2016–17 and 2017–18, respectively. Conclusions: Our study suggests the new A(H1N1)pdm09 vaccine component conferred good protection against circulating strains, while VE against A(H3N2) was <35% in 2016–17 and 2017–18. The egg propagation derived antigenic mismatch of the vaccine seed virus with circulating strains may have contributed to this low effectiveness. A(H3N2) seed viruses for vaccines in subsequent seasons may be subject to the same adaptations; in years with lower than expected VE, recommendations of preventive measures other than vaccination should be given in a timely manner. Keywords: Influenza, Influenza vaccine, Vaccine effectiveness, Multicentre study, Case-control study, Europe
