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. 2022 Apr 28;74(8):1329-1337.
doi: 10.1093/cid/ciab654.

Vaccine Effectiveness Against Acute Respiratory Illness Hospitalizations for Influenza-Associated Pneumonia During the 2015-2016 to 2017-2018 Seasons: US Hospitalized Adult Influenza Vaccine Effectiveness Network (HAIVEN)

Shekhar Ghamande  1   2 , Courtney Shaver  1 , Kempapura Murthy  1 , Chandni Raiyani  1 , Heath D White  1   2 , Tasnim Lat  1   2 , Alejandro C Arroliga  1   2 , Dayna Wyatt  3 , H Keipp Talbot  3 , Emily T Martin  4 , Arnold S Monto  4 , Richard K Zimmerman  5 , Donald B Middleton  5 , Fernanda P Silveira  5 , Jill M Ferdinands  6 , Manish M Patel  6 , Manjusha Gaglani  1   2
Affiliations

Vaccine Effectiveness Against Acute Respiratory Illness Hospitalizations for Influenza-Associated Pneumonia During the 2015-2016 to 2017-2018 Seasons: US Hospitalized Adult Influenza Vaccine Effectiveness Network (HAIVEN)

Shekhar Ghamande et al. Clin Infect Dis. .

Abstract

Background: Evidence for vaccine effectiveness (VE) against influenza-associated pneumonia has varied by season, location, and strain. We estimate VE against hospitalization for radiographically identified influenza-associated pneumonia during 2015-2016 to 2017-2018 seasons in the US Hospitalized Adult Influenza Vaccine Effectiveness Network (HAIVEN).

Methods: Among adults aged ≥18 years admitted to 10 US hospitals for acute respiratory illness (ARI), clinician-investigators used keywords from reports of chest imaging performed during 3 days around hospital admission to assign a diagnosis of "definite/probable pneumonia." We used a test-negative design to estimate VE against hospitalization for radiographically identified laboratory-confirmed influenza-associated pneumonia, comparing reverse transcriptase-polymerase chain reaction-confirmed influenza cases with test-negative subjects. Influenza vaccination status was documented in immunization records or self-reported, including date and location. Multivariable logistic regression models were used to adjust for age, site, season, calendar-time, and other factors.

Results: Of 4843 adults hospitalized with ARI included in the primary analysis, 266 (5.5%) had "definite/probable pneumonia" and confirmed influenza. Adjusted VE against hospitalization for any radiographically confirmed influenza-associated pneumonia was 38% (95% confidence interval [CI], 17-53%); by type/subtype, it was 74% (95% CI, 52-87%) influenza A (H1N1)pdm09, 25% (95% CI, -15% to 50%) A (H3N2), and 23% (95% CI, -32% to 54%) influenza B. Adjusted VE against intensive care for any influenza was 57% (95% CI, 19-77%).

Conclusions: Influenza vaccination was modestly effective among adults in preventing hospitalizations and the need for intensive care associated with influenza pneumonia. VE was significantly higher against A (H1N1)pdm09 and was low against A (H3N2) and B.

Keywords: case-control study; hospitalization; influenza vaccine effectiveness; pneumonia; test-negative.

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Figures

Figure 1.
Figure 1.
Influenza-associated pneumonia cases by predominant A subtype and B lineage (N = 251 of a total of 266 cases) in US HAIVEN during 2015–2016 to 2017–2018 seasons. Influenza cases were radiographically identified “definite/probable pneumonia” confirmed for influenza by clinical/research single-plex or multiplex RT-PCR. Abbreviations: RT-PCR, reverse transcriptase–polymerase chain reaction; US HAIVEN, US Hospitalized Adult Influenza Vaccine Effectiveness Network.
Figure 2.
Figure 2.
Adjusted vaccine effectiveness against hospitalizations for acute respiratory illness with influenza-associated pneumonia in adults aged ≥18 years: US HAIVEN, 2015–2016 to 2017–2018. Influenza cases were radiographically identified “definite/probable pneumonia” confirmed for influenza by clinical/research single-plex or multiplex RT-PCR. Abbreviations: CI, confidence interval; RT-PCR, reverse transcriptase–polymerase chain reaction; US HAIVEN, US Hospitalized Adult Influenza Vaccine Effectiveness Network; VE, vaccine effectiveness.
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