欧洲2013 - 2014年I - MOVE多中心病例对照研究。针对甲型（H1N1）pdm09流感病毒，流感疫苗有效性表现出一致性且处于中等水平；而针对甲型（H3N2）流感病毒，不同国家的研究结果存在差异。
The European I-MOVE Multicentre 2013-2014 Case-Control Study. Homogeneous moderate influenza vaccine effectiveness against A(H1N1)pdm09 and heterogenous results by country against A(H3N2).
作者信息
Valenciano Marta, Kissling Esther, Reuss Annicka, Jiménez-Jorge Silvia, Horváth Judit K, Donnell Joan M O, Pitigoi Daniela, Machado Ausenda, Pozo Francisco
机构信息
Epidemiology Department, EpiConcept, Paris, France.
Epidemiology Department, EpiConcept, Paris, France.
出版信息
Vaccine. 2015 Jun 4;33(24):2813-22. doi: 10.1016/j.vaccine.2015.04.012. Epub 2015 Apr 28.
BACKGROUND
In the first five I-MOVE (Influenza Monitoring Vaccine Effectiveness in Europe) influenza seasons vaccine effectiveness (VE) results were relatively homogenous among participating study sites. In 2013-2014, we undertook a multicentre case-control study based on sentinel practitioner surveillance networks in six European Union (EU) countries to measure 2013-2014 influenza VE against medically-attended influenza-like illness (ILI) laboratory-confirmed as influenza. Influenza A(H3N2) and A(H1N1)pdm09 viruses co-circulated during the season.
METHODS
Practitioners systematically selected ILI patients to swab within eight days of symptom onset. We compared cases (ILI positive to influenza A(H3N2) or A(H1N1)pdm09) to influenza negative patients. We calculated VE for the two influenza A subtypes and adjusted for potential confounders. We calculated heterogeneity between sites using the I(2) index and Cochrane's Q test. If the I(2) was <50%, we estimated pooled VE as (1 minus the OR)×100 using a one-stage model with study site as a fixed effect. If the I(2) was >49% we used a two-stage random effects model.
RESULTS
We included in the A(H1N1)pdm09 analysis 531 cases and 1712 controls and in the A(H3N2) analysis 623 cases and 1920 controls. For A(H1N1)pdm09, the Q test (p=0.695) and the I(2) index (0%) suggested no heterogeneity of adjusted VE between study sites. Using a one-stage model, the overall pooled adjusted VE against influenza A(H1N1)pdm2009 was 47.5% (95% CI: 16.4-67.0). For A(H3N2), the I(2) was 51.5% (p=0.067). Using a two-stage model for the pooled analysis, the adjusted VE against A(H3N2) was 29.7 (95% CI: -34.4-63.2).
CONCLUSIONS
The results suggest a moderate 2013-2014 influenza VE against A(H1N1)pdm09 and a low VE against A(H3N2). The A(H3N2) estimates were heterogeneous among study sites. Larger sample sizes by study site are needed to prevent statistical heterogeneity, decrease variability and allow for two-stage pooled VE for all subgroup analyses.
背景
在流感监测疫苗效力欧洲（I-MOVE）的前五个流感季节中，参与研究的各站点间疫苗效力（VE）结果相对一致。2013 - 2014年，我们基于六个欧盟国家的哨点医生监测网络开展了一项多中心病例对照研究，以测定2013 - 2014年流感疫苗针对经医学诊断为流感样疾病（ILI）且实验室确诊为流感的效力。该季节甲型（H3N2）流感病毒和甲型（H1N1）pdm09流感病毒共同流行。
方法
医生在症状出现的八天内系统地选择ILI患者进行拭子采样。我们将病例（ILI检测为甲型（H3N2）或甲型（H1N1）pdm09流感阳性）与流感检测阴性的患者进行比较。我们计算了两种甲型流感亚型的疫苗效力，并对潜在的混杂因素进行了调整。我们使用I²指数和Cochrane's Q检验计算各站点间的异质性。如果I²<50%，我们使用以研究站点为固定效应的单阶段模型，将合并的疫苗效力估计为（1减去比值比）×100。如果I²>49%，我们使用两阶段随机效应模型。
结果
在甲型（H1N1）pdm09分析中，我们纳入了531例病例和1712例对照；在甲型（H3N2）分析中，纳入了623例病例和1920例对照。对于甲型（H1N1）pdm09，Q检验（p = 0.695）和I²指数（0%）表明研究站点间调整后的疫苗效力不存在异质性。使用单阶段模型，针对甲型（H1N1）pdm2009的总体合并调整后疫苗效力为47.5%（95%置信区间：16.4 - 67.0）。对于甲型（H3N2），I²为51.5%（p = 0.067）。使用两阶段模型进行合并分析，针对甲型（H3N2）的调整后疫苗效力为29.7（95%置信区间： - 34.4 - 63.2）。
结论
结果表明，2013 - 2014年流感疫苗针对甲型（H1N1）pdm09的效力中等，针对甲型（H3N2）的效力较低。各研究站点针对甲型（H3N2）的估计结果存在异质性。需要增加各研究站点的样本量，以防止统计异质性，减少变异性，并允许对所有亚组分析进行两阶段合并疫苗效力分析。
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