Abstract
BackgroundPhysicians of the Spanish Influenza Sentinel Surveillance System report and systematically swab patients attended to their practices for influenza-like illness (ILI). Within the surveillance system, some Spanish regions also participated in an observational study aiming at estimating influenza vaccine effectiveness (cycEVA study). During the season 2009-2010, we estimated pandemic influenza vaccine effectiveness using both the influenza surveillance data and the cycEVA study.MethodsWe conducted two case-control studies using the test-negative design, between weeks 48/2009 and 8/2010 of the pandemic season. The surveillance-based study included all swabbed patients in the sentinel surveillance system. The cycEVA study included swabbed patients from seven Spanish regions. Cases were laboratory-confirmed pandemic influenza A(H1N1)2009. Controls were ILI patients testing negative for any type of influenza. Variables collected in both studies included demographic data, vaccination status, laboratory results, chronic conditions, and pregnancy. Additionally, cycEVA questionnaire collected data on previous influenza vaccination, smoking, functional status, hospitalisations, visits to the general practitioners, and obesity. We used logistic regression to calculate adjusted odds ratios (OR), computing pandemic influenza vaccine effectiveness as (1-OR)*100.ResultsWe included 331 cases and 995 controls in the surveillance-based study and 85 cases and 351 controls in the cycEVA study. We detected nine (2.7%) and two (2.4%) vaccine failures in the surveillance-based and cycEVA studies, respectively. Adjusting for variables collected in surveillance database and swabbing month, pandemic influenza vaccine effectiveness was 62% (95% confidence interval (CI): -5; 87). The cycEVA vaccine effectiveness was 64% (95%CI: -225; 96) when adjusting for common variables with the surveillance system and 75% (95%CI: -293; 98) adjusting for all variables collected.ConclusionPoint estimates of the pandemic influenza vaccine effectiveness suggested a protective effect of the pandemic vaccine against laboratory-confirmed influenza A(H1N1)2009 in the season 2009-2010. Both studies were limited by the low vaccine coverage and the late start of the vaccination campaign. Routine influenza surveillance provides reliable estimates and could be used for influenza vaccine effectiveness studies in future seasons taken into account the surveillance system limitations.
Highlights
Physicians of the Spanish Influenza Sentinel Surveillance System report and systematically swab patients attended to their practices for influenza-like illness (ILI)
In April 2009, Spain reported the first case of pandemic influenza A(H1N1)2009 infection in Europe [1] and since the pandemic virus activity was monitored by the Spanish Influenza Sentinel Surveillance System (SISSS)
We found that more than 40% of influenza laboratory confirmed cases notified to the surveillance system did not meet the European Union (EU) ILI case definition, suggesting that the clinical judgement of the sentinel physicians might be useful for the recruitment of true positive cases
Summary
Physicians of the Spanish Influenza Sentinel Surveillance System report and systematically swab patients attended to their practices for influenza-like illness (ILI). Some Spanish regions participated in an observational study aiming at estimating influenza vaccine effectiveness (cycEVA study). During the season 2009-2010, we estimated pandemic influenza vaccine effectiveness using both the influenza surveillance data and the cycEVA study. In April 2009, Spain reported the first case of pandemic influenza A(H1N1)2009 infection in Europe [1] and since the pandemic virus activity was monitored by the Spanish Influenza Sentinel Surveillance System (SISSS). To better monitor the pandemic influenza, the 17 Spanish regional sentinel networks integrated in the surveillance system increased the number of sentinel general practitioners and paediatricians participating in influenza surveillance and introduced systematic swabbing of patients. The routine vaccination campaign was conducted between September and November 2009 using a seasonal vaccine [7] similar to the 2008-2009 one
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