Saito Nobuo, Komori Kazuhiro, Suzuki Motoi, Morimoto Kounosuke, Kishikawa Takayuki, Yasaka Takahiro, Ariyoshi Koya
Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki, Japan; Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
Kamigoto Hospital, Nagasaki, Japan.
Vaccine. 2017 Jan 23;35(4):687-693. doi: 10.1016/j.vaccine.2016.11.024. Epub 2016 Dec 30.
Accumulating evidences indicate that repeated influenza vaccination has negative impact on the vaccine effectiveness (VE). However no published studies considered past influenza infection when assessing the VE of repeated vaccination.
Prospective surveillance was conducted from 2009 to 2012 at a community hospital on a small island in Japan. The study included all outpatients with an influenza-like illness (ILI) who attended the hospital, and a rapid diagnostic test (RDT) was used to diagnose influenza A/B infection. The VE of trivalent inactivated influenza vaccine (TIV) against medically attended influenza A (MA-fluA) was estimated using a test-negative case-control study design. The influence of TIV in the prior season on VE in the current season was investigated in the context of MA-fluA during the prior season.
During the three influenza seasons, 5838 ILI episodes (4127 subjects) were analysed. Subjects who had an episode of MA-fluA in the prior season were at a significantly lower risk of MA-fluA in the current season (adjusted odds ratio: 0.38, 95% CI: 0.30-0.50). The overall adjusted VE was 28% (95% CI, 14-40). VE was substantially lower in subjects vaccinated in the prior season compared to those who had not been vaccinated in prior season (19%; 95% CI: 0-35 vs 46%; 95% CI: 26-60, test for interaction, P value <0.05). In subjects who did not have MA-fluA in the prior season showed the attenuation of VE due to repeated vaccination (13%; 95% CI: -7 to 30 vs 44%; 95% CI: 24-59, test for interaction, P<0.05). However this effect was not detected in subjects who had contracted MA-fluA in the prior season.
Negative effects of repeated vaccination were significant among those without history of MA-fluA in the prior season.
越来越多的证据表明，重复接种流感疫苗会对疫苗效力（VE）产生负面影响。然而，在评估重复接种疫苗的VE时，尚无已发表的研究考虑既往流感感染情况。
2009年至2012年在日本一个小岛上的社区医院进行前瞻性监测。该研究纳入了所有到该医院就诊的患有流感样疾病（ILI）的门诊患者，并使用快速诊断试验（RDT）诊断甲型/乙型流感感染。采用检测阴性病例对照研究设计估计三价灭活流感疫苗（TIV）针对就诊的甲型流感（MA-fluA）的VE。在既往季节MA-fluA的背景下，研究前一季TIV对当前季节VE的影响。
在三个流感季节期间，分析了5838例ILI发作（4127名受试者）。前一季有MA-fluA发作的受试者在当前季节患MA-fluA的风险显著较低（调整后的优势比：0.38，95%置信区间：0.30-0.50）。总体调整后的VE为28%（95%置信区间，14-40）。与前一季未接种疫苗的受试者相比，前一季接种疫苗的受试者的VE显著更低（19%；95%置信区间：0-35 vs 46%；95%置信区间：26-60，交互作用检验，P值<0.05）。在前一季没有MA-fluA的受试者中，重复接种疫苗导致VE减弱（13%；95%置信区间：-7至30 vs 44%；95%置信区间：24-59，交互作用检验，P<0.05）。然而，在前一季感染过MA-fluA的受试者中未检测到这种效应。
在前一季没有MA-fluA病史的人群中，重复接种疫苗的负面影响显著。
