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Observational Study
. 2019 Aug;24(31):1800488.
doi: 10.2807/1560-7917.ES.2019.24.31.1800488.

End of season influenza vaccine effectiveness in adults and children in the United Kingdom in 2017/18

Richard Pebody  1 , Abdelmajid Djennad  1 , Joanna Ellis  1 , Nick Andrews  1 , Diogo F P Marques  2 , Simon Cottrell  3 , Arlene J Reynolds  2 , Rory Gunson  4 , Monica Galiano  1 , Katja Hoschler  1 , Angie Lackenby  1 , Chris Robertson  5 , Mark O'Doherty  6 , Mary Sinnathamby  1 , Nikolaos Panagiotopoulos  1 , Ivelina Yonova  7   8 , Rebecca Webb  7 , Catherine Moore  3 , Matthew Donati  1 , Muhammad Sartaj  6 , Samantha J Shepherd  4 , Jim McMenamin  2 , Simon de Lusignan  7   8 , Maria Zambon  1
Affiliations
Observational Study

End of season influenza vaccine effectiveness in adults and children in the United Kingdom in 2017/18

Richard Pebody et al. Euro Surveill. 2019 Aug.

Abstract

BackgroundIn the United Kingdom (UK), in recent influenza seasons, children are offered a quadrivalent live attenuated influenza vaccine (LAIV4), and eligible adults mainly trivalent inactivated vaccine (TIV).AimTo estimate the UK end-of-season 2017/18 adjusted vaccine effectiveness (aVE) and the seroprevalence in England of antibodies against influenza viruses cultured in eggs or tissue.MethodsThis observational study employed the test-negative case-control approach to estimate aVE in primary care. The population-based seroprevalence survey used residual age-stratified samples.ResultsInfluenza viruses A(H3N2) (particularly subgroup 3C.2a2) and B (mainly B/Yamagata/16/88-lineage, similar to the quadrivalent vaccine B-virus component but mismatched to TIV) dominated. All-age aVE was 15% (95% confidence interval (CI): -6.3 to 32) against all influenza; -16.4% (95% CI: -59.3 to 14.9) against A(H3N2); 24.7% (95% CI: 1.1 to 42.7) against B and 66.3% (95% CI: 33.4 to 82.9) against A(H1N1)pdm09. For 2-17 year olds, LAIV4 aVE was 26.9% (95% CI: -32.6 to 59.7) against all influenza; -75.5% (95% CI: -289.6 to 21) against A(H3N2); 60.8% (95% CI: 8.2 to 83.3) against B and 90.3% (95% CI: 16.4 to 98.9) against A(H1N1)pdm09. For ≥ 18 year olds, TIV aVE against influenza B was 1.9% (95% CI: -63.6 to 41.2). The 2017 seroprevalence of antibody recognising tissue-grown A(H3N2) virus was significantly lower than that recognising egg-grown virus in all groups except 15-24 year olds.ConclusionsOverall aVE was low driven by no effectiveness against A(H3N2) possibly related to vaccine virus egg-adaption and a new A(H3N2) subgroup emergence. The TIV was not effective against influenza B. LAIV4 against influenza B and A(H1N1)pdm09 was effective.

Keywords: influenza vaccine effectiveness.

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Conflict of interest statement

Conflict of interest: SL has received university funding for studies of post vaccination adverse events of interest from GSK, and for attitudes to vaccination from Seqirus; and has been a member of Seqirus and Sanofi advisory boards. MD received lecturing fee from Sanofi Pasteur MSD; SpeeDx provided partial financial support for an educational meeting and UK Clinical Virology Network (UK CVN) which he chairs is a registered charity which includes a number of commercial partners. CM has received funding as an advisory board member of Seqirus. No other co-authors had conflicts to declare.

Figures

Figure 1
Figure 1
Swabbing results of patients with influenza-like illness in primary care in the United Kingdom, October 2017–April 2018 (n = 3,992 patients swabbed)
Figure 2
Figure 2
Phylogenetic analysis of the haemagglutinin sequences of influenza A(H3N2) viruses detected in the United Kingdom, July 2017–April 2018a
Figure 3
Figure 3
Frequency of H3N2 haemagglutinin genetic groups by month, England, September 2017–April 2018 (n = 605)
Figure 4
Figure 4
Phylogenetic analysis of the haemagglutinin sequences of influenza B viruses detected in the United Kingdom, July 2017–April 2018
Figure 5
Figure 5
Antibody seroprevalence levels by age group against (A) A/Hong Kong/4801/2014 virus either grown in tissue culture or propagated in egg or (B) B/Yamagata and B/Victoria viruses, England, United Kingdom, 2016 and 2017 (n = 1,741)
See this image and copyright information in PMC

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