Heterogeneity of Circulating Influenza Viruses and Their Impact on Influenza Virus Vaccine Effectiveness During the Influenza Seasons 2016/17 to 2018/19 in Austria

Abstract

The constantly changing pattern in the dominance of viral strains and their evolving subclades during the seasons substantially influences influenza vaccine effectiveness (IVE). In order to further substantiate the importance of detailed data of genetic virus characterization for IVE estimates during the seasons, we performed influenza virus type and subtype specific IVE estimates. IVE estimates were assessed using a test-negative case-control design, in the context of the intraseasonal changes of the heterogeneous mix of circulating influenza virus strains for three influenza seasons (2016/17 to 2018/19) in Austria. Adjusted overall IVE over the three seasons 2016/17, 2017/18, and 2018/19 were -26, 39, and 63%, respectively. In accordance with the changing pattern of the circulating strains a broad range of overall and subtype specific IVEs was obtained: A(H3N2) specific IVE ranged between -26% for season 2016/17 to 58% in season 2018/19, A(H1N1)pdm09 specific IVE was 25% for the season 2017/18 and 65% for the season 2018/19 and Influenza B specific IVE for season 2017/18 was 45%. The results obtained in our study over the three seasons demonstrate the increasingly complex dynamic of the ever changing genetic pattern of the circulating influenza viruses and their influence on IVE estimates. This emphasizes the importance of detailed genetic virus surveillance for reliable IVE estimates.

Keywords: genetic variability and vaccine effectiveness; influenza antigenic drift and influenza vaccine effectiveness; influenza genetic heterogeneity; influenza vaccine effectiveness; influenza virus.

Figure 1

Columns: number of influenza virus detections per week and per type/subtype during the influenza seasons 2016/17 to 2018/19; pie chart: proportion (%) of the circulating influenza virus types/subtypes during the respective influenza seasons.

Figure 2

Proportion (%) of circulating influenza virus genetic subclades during seasons 2016/17 to 2018/19; Black: IVE overall, blue: IVE against influenza A(H3N2), red: IVE against influenza A(H1N1)pdm09, green: IVE against Influenza B (aTIV/TIV/QIV and LAIV), bold*: IVEs using quadrivalent vaccines (QIV/LAIV) (Season 2017/18); n.d., not done due to low case numbers.