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 Kissling¹, Francisco Pozo², Silke Buda³, Ana-Maria Vilcu⁴, Caterina Rizzo^{5

6}, Alin Gherasim^{7

8}, Judit Krisztina Horváth⁹, Mia Brytting¹⁰, Lisa Domegan¹¹, Adam Meijer¹², Iwona Paradowska-Stankiewicz¹³, Ausenda Machado¹⁴, Vesna Višekruna Vučina¹⁵, Mihaela Lazar¹⁶, Kari Johansen¹⁷, Ralf Dürrwald¹⁸, Sylvie van der Werf^{19

20}, Antonino Bella⁵, Amparo Larrauri^{7

8}, Annamária Ferenczi⁹, Katherina Zakikhany¹⁰, Joan O'Donnell¹¹, Frederika Dijkstra¹², Joanna Bogusz¹³, Raquel Guiomar²¹, Sanja Kurečić Filipović¹⁵, Daniela Pitigoi²², Pasi Penttinen¹⁷, Marta Valenciano¹; I-MOVE/I-MOVE+ study team

Affiliations

¹ Epidemiology Department, Epiconcept, 47 rue de Charenton, 75012 Paris, France.
² National Centre for Microbiology, National Influenza Reference Laboratory, WHO-National Influenza Centre, Institute of Health Carlos III, Madrid, Spain.
³ Robert Koch Institute, Department of Infectious Disease Epidemiology, Respiratory Infections Unit, Seestrasse 10, 13353 Berlin, Germany.
⁴ Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75012, Paris, France.
⁵ Department of Infectious Diseases, National Institute of Health, Rome, Italy.
⁶ Bambino Gesù Children's Hospital, Rome, Italy.
⁷ National Epidemiology Centre, Institute of Health Carlos III, Madrid, Spain.
⁸ CIBER de Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid Spain.
⁹ Office of the Chief Medical Officer, Budapest, Hungary.
¹⁰ Public Health Agency of Sweden, Stockholm, Sweden.
¹¹ Health Service Executive-Health Protection Surveillance Centre, 25-27 Middle Gardiner Street, Dublin 1 D01 A4A3, Ireland.
¹² National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
¹³ National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland.
¹⁴ Departamento de Epidemiologia, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal.
¹⁵ Croatian Institute of Public Health, Zagreb, Croatia.
¹⁶ "Cantacuzino" National Medico-Military Institute for Research and Development, Bucharest, Romania.
¹⁷ European Centre for Disease Prevention and Control (ECDC), Gustav III:s boulevard 40, 169 73 Solna, Sweden.
¹⁸ Robert Koch Institute, National Reference Center for Influenza, Seestrasse 10, 13353 Berlin, Germany.
¹⁹ Unité de Génétique Moléculaire des Virus à ARN, Institut Pasteur, CNRS UMR3569, Université Paris Diderot SPC, France.
²⁰ CNR des Virus des Infections Respiratoires, WHO National Influenza Center, Institut Pasteur, France.
²¹ Departamento de Doenças Infeciosas, Instituto Nacional de Saúde Dr. Ricardo Jorge, Portugal.
²² Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.

PMID: 31660536
PMCID: PMC6807025
DOI: 10.1016/j.jvacx.2019.100042

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 et al. Vaccine X. 2019.

. 2019 Sep 17:3:100042.

doi: 10.1016/j.jvacx.2019.100042. eCollection 2019 Dec 10.

Authors

Affiliations

¹ Epidemiology Department, Epiconcept, 47 rue de Charenton, 75012 Paris, France.
² National Centre for Microbiology, National Influenza Reference Laboratory, WHO-National Influenza Centre, Institute of Health Carlos III, Madrid, Spain.
³ Robert Koch Institute, Department of Infectious Disease Epidemiology, Respiratory Infections Unit, Seestrasse 10, 13353 Berlin, Germany.
⁴ Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75012, Paris, France.
⁵ Department of Infectious Diseases, National Institute of Health, Rome, Italy.
⁶ Bambino Gesù Children's Hospital, Rome, Italy.
⁷ National Epidemiology Centre, Institute of Health Carlos III, Madrid, Spain.
⁸ CIBER de Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid Spain.
⁹ Office of the Chief Medical Officer, Budapest, Hungary.
¹⁰ Public Health Agency of Sweden, Stockholm, Sweden.
¹¹ Health Service Executive-Health Protection Surveillance Centre, 25-27 Middle Gardiner Street, Dublin 1 D01 A4A3, Ireland.
¹² National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
¹³ National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland.
¹⁴ Departamento de Epidemiologia, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal.
¹⁵ Croatian Institute of Public Health, Zagreb, Croatia.
¹⁶ "Cantacuzino" National Medico-Military Institute for Research and Development, Bucharest, Romania.
¹⁷ European Centre for Disease Prevention and Control (ECDC), Gustav III:s boulevard 40, 169 73 Solna, Sweden.
¹⁸ Robert Koch Institute, National Reference Center for Influenza, Seestrasse 10, 13353 Berlin, Germany.
¹⁹ Unité de Génétique Moléculaire des Virus à ARN, Institut Pasteur, CNRS UMR3569, Université Paris Diderot SPC, France.
²⁰ CNR des Virus des Infections Respiratoires, WHO National Influenza Center, Institut Pasteur, France.
²¹ Departamento de Doenças Infeciosas, Instituto Nacional de Saúde Dr. Ricardo Jorge, Portugal.
²² Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.

PMID: 31660536
PMCID: PMC6807025
DOI: 10.1016/j.jvacx.2019.100042

Abstract

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: Case-control study; Europe; Influenza; Influenza vaccine; Multicentre study; Vaccine effectiveness.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

**Fig. 1**
Number of ILI patients by case status (test negative controls and cases by influenza (sub)type) and week of symptom onset, I-MOVE/I-MOVE+ primary care multicenter case control study, Europe, influenza seasons 2016–17 and 2017–18. ILI: Influenza-like illness; ISO: International Organization for Standardization.

See this image and copyright information in PMC

References

1. ECDC, ‘Influenza virus characterisation - Summary Europe, June 2016’, Jul. 2016.
1. C. Adlhoch, R. Snacken, A. Melidou, S. Ionescu, P. Penttinen, and The European Influenza Surveillance Network, ‘Dominant influenza A(H3N2) and B/Yamagata virus circulation in EU/EEA, 2016/17 and 2017/18 seasons, respectively’, Euro Surveill. Bull. Eur. Sur Mal. Transm. Eur. Commun. Dis. Bull., vol. 23, no. 13, 2018. - PMC - PubMed
1. Vestergaard L.S. Excess all-cause and influenza-attributable mortality in Europe, December 2016 to February 2017. Euro. Surveill. Bull. Eur. Sur Mal. Transm. Eur. Commun. Dis. Bull. 2017;22(14) Apr. - PMC - PubMed
1. EuroMOMO, ‘European monitoring of excess mortality for public health action - EuroMOMO’. [Online]. Available: [Accessed: 14-Aug-2018]. http://www.euromomo.eu/index.html.
1. Valenciano M., Ciancio B., I-MOVE study team I-MOVE: a European network to measure the effectiveness of influenza vaccines. Euro Surveill. Bull. Eur. Sur Mal. Transm. Eur. Commun. Dis. Bull. 2012;17(39) Sep. - PubMed

LinkOut - more resources

Full Text Sources

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

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)

Affiliations

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)

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources