2022 - 2023年流感疫苗对疾病和无症状感染的有效性：一项前瞻性队列研究

Influenza Vaccine Effectiveness Against Illness and Asymptomatic Infection in 2022-2023: A Prospective Cohort Study.

作者信息

White Elizabeth B, Grant Lauren, Mak Josephine, Olsho Lauren, Edwards Laura J, Naleway Allison, Burgess Jefferey L, Ellingson Katherine D, Tyner Harmony, Gaglani Manjusha, Lutrick Karen, Caban-Martinez Alberto, Newes-Adeyi Gabriella, Duque Jazmin, Yoon Sarang K, Phillips Andrew L, Thompson Mark, Britton Amadea, Flannery Brendan, Fowlkes Ashley

机构信息

Influenza Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, USA.

Epidemic Intelligence Service, CDC, Atlanta, Georgia, USA.

出版信息

Clin Infect Dis. 2025 Apr 30;80(4):893-900. doi: 10.1093/cid/ciae491.

DOI:10.1093/cid/ciae491

PMID:39446477

Abstract

BACKGROUND

Previous estimates of vaccine effectiveness (VE) against asymptomatic influenza virus infection based on seroconversion have varied widely and may be biased. We estimated 2022-2023 influenza VE against illness and asymptomatic infection in a prospective cohort.

METHODS

In the HEROES-RECOVER cohort, adults at increased occupational risk of influenza exposure across 7 US sites provided weekly symptom reports and nasal swabs for reverse transcription-polymerase chain reaction (RT-PCR) influenza testing. Laboratory-confirmed influenza virus infections were classified as symptomatic (≥1 symptom) or asymptomatic during the week of testing. Participants reported demographic information and vaccination through surveys; most sites verified vaccination through medical record and immunization registry review. Person-time was calculated as days from the site-specific influenza season start (September-October 2022) through date of infection, study withdrawal, or season end (May 2023). We compared influenza incidence among vaccinated versus unvaccinated participants overall, by symptom status, and by influenza A subtype, using Cox proportional hazards regression adjusted for site and occupation. We estimated VE as (1 - adjusted hazard ratio) × 100%.

RESULTS

In total, 269 of 3785 (7.1%) participants had laboratory-confirmed influenza, including 263 (98%) influenza A virus infections and 201 (75%) symptomatic illnesses. Incidence of laboratory-confirmed influenza illness among vaccinated versus unvaccinated participants was 23.7 and 33.2 episodes per 100 000 person-days, respectively (VE: 38%; 95% CI: 15%-55%). Incidence of asymptomatic influenza virus infection was 8.0 versus 11.6 per 100 000 (VE: 13%; 95% CI: -47%, 49%).

CONCLUSIONS

Vaccination reduced incidence of symptomatic but not asymptomatic influenza virus infection, suggesting that influenza vaccination attenuates progression from infection to illness.

摘要

背景

以往基于血清转化对无症状流感病毒感染的疫苗效力（VE）估计差异很大，且可能存在偏差。我们在一个前瞻性队列中估计了2022 - 2023年流感疫苗对疾病和无症状感染的效力。

方法

在HEROES - RECOVER队列中，美国7个地点职业性接触流感风险增加的成年人每周提供症状报告和用于逆转录 - 聚合酶链反应（RT - PCR）流感检测的鼻拭子。实验室确诊的流感病毒感染在检测周被分类为有症状（≥1种症状）或无症状。参与者通过调查报告人口统计学信息和疫苗接种情况；大多数地点通过病历和免疫登记审查核实疫苗接种情况。人时计算为从特定地点流感季节开始（2022年9月 - 10月）到感染日期、研究退出或季节结束（2023年5月）的天数。我们使用针对地点和职业进行调整的Cox比例风险回归，比较了接种疫苗与未接种疫苗参与者总体、按症状状态以及按甲型流感亚型的流感发病率。我们将疫苗效力估计为（1 - 调整后的风险比）×100%。

结果

在3785名参与者中，共有269名（7.1%）实验室确诊流感，其中包括263例（98%）甲型流感病毒感染和201例（75%）有症状疾病。接种疫苗与未接种疫苗参与者中实验室确诊流感疾病的发病率分别为每100 000人日23.7例和33.2例（疫苗效力：38%；95%置信区间：15% - 55%）。无症状流感病毒感染的发病率为每100 000人8.0例和11.6例（疫苗效力：13%；95%置信区间： - 47%，49%）。