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. 2019 May 2;19(1):487.
doi: 10.1186/s12889-019-6713-5.

Influenza epidemiology and influenza vaccine effectiveness during the 2016-2017 season in the Global Influenza Hospital Surveillance Network (GIHSN)

Víctor Baselga-Moreno  1 , Svetlana Trushakova  2 , Shelly McNeil  3 , Anna Sominina  4 , Marta C Nunes  5   6 , Anca Draganescu  7 , Serhat Unal  8 , Parvaiz Koul  9 , Jan Kyncl  10 , Tao Zhang  11 , Ainagul Kuatbayeva  12 , Afif Ben-Salah  13   14 , Elena Burtseva  2 , Joan Puig-Barberà  1 , Javier Díez-Domingo  15 ; Global Influenza Hospital Surveillance Network (GIHSN)
Collaborators, Affiliations

Influenza epidemiology and influenza vaccine effectiveness during the 2016-2017 season in the Global Influenza Hospital Surveillance Network (GIHSN)

Víctor Baselga-Moreno et al. BMC Public Health. .

Abstract

Background: The Global Influenza Hospital Surveillance Network (GIHSN) aims to determine the burden of severe influenza disease and Influenza Vaccine Effectiveness (IVE). This is a prospective, active surveillance and hospital-based epidemiological study to collect epidemiological data in the GIHSN. In the 2016-2017 influenza season, 15 sites in 14 countries participated in the GIHSN, although the analyses could not be performed in 2 sites. A common core protocol was used in order to make results comparable. Here we present the results of the GIHSN 2016-2017 influenza season.

Methods: A RT-PCR test was performed to all patients that accomplished the requirements detailed on a common core protocol. Patients admitted were included in the study after signing the informed consent, if they were residents, not institutionalised, not discharged in the previous 30 days from other hospitalisation with symptoms onset within the 7 days prior to admission. Patients 5 years old or more must also complied the Influenza-Like Illness definition. A test negative-design was implemented to perform IVE analysis. IVE was estimated using a logistic regression model, with the formula IVE = (1-aOR) × 100, where aOR is the adjusted Odds Ratio comparing cases and controls.

Results: Among 21,967 screened patients, 10,140 (46.16%) were included, as they accomplished the inclusion criteria, and tested, and therefore 11,827 (53.84%) patients were excluded. Around 60% of all patients included with laboratory results were recruited at 3 sites. The predominant strain was A(H3N2), detected in 63.6% of the cases (1840 patients), followed by B/Victoria, in 21.3% of the cases (618 patients). There were 2895 influenza positive patients (28.6% of the included patients). A(H1N1)pdm09 strain was mainly found in Mexico. IVE could only be performed in 6 sites separately. Overall IVE was 27.24 (95% CI 15.62-37.27. Vaccination seemed to confer better protection against influenza B and in people 2-4 years, or 85 years old or older. The aOR for hospitalized and testing positive for influenza was 3.02 (95% CI 1.59-5.76) comparing pregnant with non-pregnant women.

Conclusions: Vaccination prevented around 1 in 4 hospitalisations with influenza. Sparse numbers didn't allow estimating IVE in all sites separately. Pregnancy was found a risk factor for influenza, having 3 times more risk of being admitted with influenza for pregnant women.

Keywords: Epidemiology; Influenza virus; Surveillance; Vaccine effectiveness.

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Conflict of interest statement

Ethics approval and consent to participate

This study has been approved by the Ethics Committees of the participating sites, who have approved their participation in the GIHSN network. Each adult patient tested for influenza had signed an informed consent in order to be included in the study. In case the patient did not reach the legal age or is impaired, parents or legal guardians signed the informed consent. The Ethics Committees of the participating sites are listed below:

  1. St. Petersburg: Local Ethical Committee under the FGBU “Research Institute of Influenza” of the Ministry of Health of the Russian Federation

  2. Moscow: The local Ethic Committee of Hospital #1 for Infectious Diseases of Moscow Health Department

  3. Kazakhstan: The study was carried in Almaty, Kazakhstan as part of the implementation of the national Severe Acute Respiratory Infections (SARI) surveillance program in Kazakhstan for purposes of communicable disease control. Ethical approval was not required but informed consent was obtained before inclusion. Informed consent provided in accordance with the Constitution of the Republic of Kazakhstan (section II article 29)

  4. Czech Republic: Ethics Committee of the Hospital Na Bulovce

  5. Canada: The Nova Scotia Health Authority Research Ethics Board and the IWK Research Ethics Board (IWK: Isaak Walton Killam)

  6. Romania: Bioethics Committee of the National Institute for Infectious Diseases “Prof. Dr. Matei Bals” Bucharest, Romania

  7. Turkey: Hacettepe University Non-interventional Clinical Research Ethics Board

  8. Valencia: Comité Ético de Investigación Clínica Dirección General de Salud Pública-Centro Superior de Investigación en Salud Pública (CEIC-DGSP-CSISP)

  9. Tunisia: The ethics committee of Abderrahmane Mami hospital, Ariana, Tunisia

  10. Suzhou/Shanghai: Fudan University School of Public Health Institutional Review Board

  11. India: Institutional Ethics Committee of the Sher-i-Kashmir Institute of Medical Sciences, Srinagar

  12. Mexico: Research Ethics Committee of the National Institute of Medical Science and Nutrition Salvador Zubiran & Research Committee of the National Institute of Medical Science and Nutrition Salvador Zubiran

  13. South Africa: The Human Research Ethics Committee of the University of the Witwatersrand

All of these Ethics Committees approved the participation of the site in the study and the data transfer to FISABIO, who led the implementation and data collection in the 2016–2017 season.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Overview of the methodology used by the GIHSN
Fig. 2
Fig. 2
Influenza-associated admissions by epidemiological week and virus type/subtype
Fig. 3
Fig. 3
Admissions with influenza by site, epidemiological week and virus type/subtype
Fig. 4
Fig. 4
Percentages of influenza-associated admissions by age group and type/subtype
Fig. 5
Fig. 5
Admissions with influenza by site, age group and virus type/subtype
Fig. 6
Fig. 6
Adjusted Odds Ratio (aOR) and number of admissions with influenza according to comorbidity
Fig. 7
Fig. 7
Predicted probability of having an admission with influenza in pregnant and non-pregnant women by trimester
Fig. 8
Fig. 8
Predicted probability of severe outcome by strain
Fig. 9
Fig. 9
Vaccination coverage in targeted groups by site
Fig. 10
Fig. 10
Adjusted Influenza Vaccine Effectiveness by site
Fig. 11
Fig. 11
Adjusted Influenza Vaccine Effectiveness by strain
Fig. 12
Fig. 12
Adjusted Influenza Vaccine Effectiveness by age group
See this image and copyright information in PMC

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