在加拿大的 4 个流感季中，既往季节接种对后续流感疫苗预防与流感相关住院的效果的影响。

The Impact of Prior Season Vaccination on Subsequent Influenza Vaccine Effectiveness to Prevent Influenza-related Hospitalizations Over 4 Influenza Seasons in Canada.

机构信息

Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia.

Centre Hospitalier Universitaire de Québec, Québec City, Canada.

出版信息

Clin Infect Dis. 2019 Aug 30;69(6):970-979. doi: 10.1093/cid/ciy1009.

DOI:10.1093/cid/ciy1009

PMID:30508064

Abstract

BACKGROUND

Recent studies have demonstrated the possibility of negative associations between prior influenza vaccines and subsequent influenza vaccine effectiveness (VE), depending on season and strain. We investigated this association over 4 consecutive influenza seasons (2011-2012 through 2014-2015) in Canada.

METHODS

Using a matched test-negative design, laboratory-confirmed influenza cases and matched test-negative controls admitted to hospitals were enrolled. Patients were stratified into 4 groups according to influenza vaccine history (not vaccinated current and prior season [referent], vaccinated prior season only, vaccinated current season only, and vaccinated both current and prior season). Conditional logistic regression was used to estimate VE; prior vaccine impact was assessed each season for overall effect and effect stratified by age (<65 years, ≥65 years) and type/subtype (A/H1N1, A/H3N2, influenza B).

RESULTS

Overall, mainly nonsignificant associations were observed. Trends of nonsignificant decreased VE among patients repeatedly vaccinated in both prior and current season relative to the current season only were observed in the A/H3N2-dominant seasons of 2012-2013 and 2014-2015. Conversely, in 2011-2012, during which B viruses circulated, and in 2013-2014, when A/H1N1 circulated, being vaccinated in both seasons tended to result in a high VE in the current season against the dominant circulating subtype.

CONCLUSIONS

Prior vaccine impact on subsequent VE among Canadian inpatients was mainly nonsignificant. Even in circumstances where we observed a trend of negative impact, being repeatedly vaccinated was still more effective than not receiving the current season's vaccine. These findings favor continuation of annual influenza vaccination recommendations, particularly in older adults.

CLINICAL TRIALS REGISTRATION

NCT01517191.

摘要

背景

最近的研究表明，流感疫苗与随后的流感疫苗效力（VE）之间可能存在负相关，这取决于季节和毒株。我们在加拿大连续 4 个流感季节（2011-2012 年至 2014-2015 年）中对此关联进行了研究。

方法

使用匹配的阴性对照测试设计，我们招募了实验室确诊的流感病例和匹配的阴性对照住院患者。根据流感疫苗接种史（当前和既往季节未接种[参照组]、既往季节接种、当前季节接种、当前和既往季节均接种），将患者分为 4 组。使用条件逻辑回归估计 VE；每个季节都评估既往疫苗的影响，评估总体效果以及按年龄（<65 岁、≥65 岁）和类型/亚型（A/H1N1、A/H3N2、B 型流感）分层的效果。

结果

总体而言，观察到的主要是无显著关联。在 A/H3N2 占主导地位的 2012-2013 年和 2014-2015 年季节中，观察到既往和当前季节均重复接种疫苗的患者 VE 显著降低的趋势，而在 2011-2012 年 B 型病毒流行期间和 2013-2014 年 A/H1N1 流行期间，两季均接种疫苗会导致当前季节针对主要流行亚型的高 VE。