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Seasonal Influenza Vaccine Effectiveness for the Prevention of Laboratory-Confirmed Influenza in Asthma During the Influenza Seasons 2010-11 to 2015-16 in Scotland: A National Test-Negative Design Case-Control Study

40 Pages Posted: 15 May 2019

See all articles by Eleftheria Vasileiou

Eleftheria Vasileiou

University of Edinburgh - Asthma UK Centre for Applied Research

Aziz Sheikh

University of Edinburgh - Asthma UK Centre for Applied Research

Christopher C. Butler

University of Oxford - Department of Primary Care Health Sciences

Chris Robertson

University of Strathclyde - Department of Mathematics & Statistics

Kimberley Kavanagh

University of Strathclyde - Department of Mathematics & Statistics

Tanya Englishby

University of Strathclyde - Department of Mathematics & Statistics

Nazir I. Lone

University of Edinburgh - Asthma UK Centre for Applied Research

Beatrix von Wissmann

Public Health Scotland

Jim McMenamin

Public Health Scotland

Sir Lewis D. Ritchie

University of Aberdeen - Centre of Academic Primary Care

Jürgen Schwarze

University of Edinburgh

Rory Gunson

West of Scotland Specialist Virology Centre

Colin R. Simpson

Victoria University of Wellington - School of Health

More...

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.

Findings: Vaccination was associated with an overall 55.03% (95% confidence interval (CI): 45.84-62.66) 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 (76.08%; 95% CI: 55.60-87.12) 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: 70.68%; 95%CI: 32.46-87.27) and B strains (e.g. 2010/11: 83.17%; 95%CI: 44.31-94.92), but there was lower protection for the A(H3N2) strain (e.g. 2014/15: 26.40%; 95%CI: -12.00-51.64). The highest VE against all viral strains was observed in adults aged 18-54 years (56.98%; 95%CI: 42.25-67.95).

Interpretation: 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.

Funding Statement: Chief Scientist's Office of the Scottish Government, National Institute for Health Research - Health Technology Assessment Programme (13/34/14), Asthma UK and the Medical Research Council's Farr Institute, Health Data Research UK (HDR UK).

Declaration of Interests: The authors declare no competing interests.

Ethics Approval Statement: The Privacy Advisory Committee of the Information Services Division, NSS, approved the linkage and the statistical analysis of the anonymised data used in this study.

Suggested Citation

Vasileiou, Eleftheria and Sheikh, Aziz and Butler, Christopher C. and Robertson, Chris and Kavanagh, Kimberley and Englishby, Tanya and Lone, Nazir I. and von Wissmann, Beatrix and McMenamin, Jim and Ritchie, Sir Lewis D. and Schwarze, Jürgen and Gunson, Rory and Simpson, Colin R., Seasonal Influenza Vaccine Effectiveness for the Prevention of Laboratory-Confirmed Influenza in Asthma During the Influenza Seasons 2010-11 to 2015-16 in Scotland: A National Test-Negative Design Case-Control Study (May 13, 2019). Available at SSRN: https://ssrn.com/abstract=3387515 or http://dx.doi.org/10.2139/ssrn.3387515

Eleftheria Vasileiou (Contact Author)

University of Edinburgh - Asthma UK Centre for Applied Research ( email )

Edinburgh
United Kingdom

Aziz Sheikh

University of Edinburgh - Asthma UK Centre for Applied Research ( email )

Edinburgh
United Kingdom

Christopher C. Butler

University of Oxford - Department of Primary Care Health Sciences

United Kingdom

Chris Robertson

University of Strathclyde - Department of Mathematics & Statistics

26 Richmond Street
Glasgow G1 1XH
United Kingdom

Kimberley Kavanagh

University of Strathclyde - Department of Mathematics & Statistics

26 Richmond Street
Glasgow G1 1XH
United Kingdom

Tanya Englishby

University of Strathclyde - Department of Mathematics & Statistics

26 Richmond Street
Glasgow G1 1XH
United Kingdom

Nazir I. Lone

University of Edinburgh - Asthma UK Centre for Applied Research

Edinburgh
United Kingdom

Beatrix Von Wissmann

Public Health Scotland

Glasgow, Scotland
United Kingdom

Jim McMenamin

Public Health Scotland

Glasgow, Scotland
United Kingdom

Sir Lewis D. Ritchie

University of Aberdeen - Centre of Academic Primary Care

Dunbar Street
Aberdeen, Scotland AB24 3QY
United Kingdom

Jürgen Schwarze

University of Edinburgh

Old College
South Bridge
Edinburgh, Scotland EH8 9JY
United Kingdom

Rory Gunson

West of Scotland Specialist Virology Centre

Glasgow, Scotland
United Kingdom

Colin R. Simpson

Victoria University of Wellington - School of Health

P.O. Box 600
Wellington, 6140
New Zealand

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