The impact of repeated vaccination using 10-year vaccination history on protection against influenza in older adults: a test-negative design study across the 2010/11 to 2015/16 influenza seasons in Ontario, Canada

Kwong, Jeffrey C.; Chung, Hannah; Jung, Jette; Buchan, Sarah A; Campigotto, Aaron; Campitelli, Michael A.; Crowcroft, Natasha S.; Gubbay, Jonathan B.; Karnauchow, Timothy; Katz, Kevin; McGeer, Allison; McNally, James Dayre; Richardson, David; Richardson, Susan E.; Rosella, Laura; Schwartz, Kevin L; Simor, Andrew E.; Śmieja, Marek; Zahariadis, George

doi:10.2807/1560-7917.es.2020.25.1.1900245

Cited by 20 publications

(30 citation statements)

References 27 publications

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“…Influenza vaccines received in previous seasons may retain a notable protective effect [3][4][5]. In contrast with that, frequent prior vaccination has been related with a reduced effect (i.e.…”

Section: Introductionmentioning

confidence: 99%

Simple models to include influenza vaccination history when evaluating the effect of influenza vaccination

et al. 2021

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Background Most reports of influenza vaccine effectiveness consider current-season vaccination only. Aim We evaluated a method to estimate the effect of influenza vaccinations (EIV) considering vaccination history. Methods We used a test-negative design with well-documented vaccination history to evaluate the average EIV over eight influenza seasons (2011/12–2018/19; n = 10,356). Modifying effect was considered as difference in effects of vaccination in current and previous seasons and current-season vaccination only. We also explored differences between current-season estimates excluding from the reference category people vaccinated in any of the five previous seasons and estimates without this exclusion or only for one or three previous seasons. Results The EIV was 50%, 45% and 38% in people vaccinated in the current season who had previously received none, one to two and three to five doses, respectively, and it was 30% and 43% for one to two and three to five prior doses only. Vaccination in at least three previous seasons reduced the effect of current-season vaccination by 12 percentage points overall, 31 among outpatients, 22 in 9–65 year-olds, and 23 against influenza B. Including people vaccinated in previous seasons only in the unvaccinated category underestimated EIV by 9 percentage points on average (31% vs 40%). Estimates considering vaccination of three or five previous seasons were similar. Conclusions Vaccine effectiveness studies should consider influenza vaccination in previous seasons, as it can retain effect and is often an effect modifier. Vaccination status in three categories (current season, previous seasons only, unvaccinated) reflects the whole EIV.

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Section: Introductionmentioning

confidence: 99%

Simple models to include influenza vaccination history when evaluating the effect of influenza vaccination

et al. 2021

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“…The mouse model allowed us to study several immune parameters and determine protection from lethal viral challenge. The study of repeat vaccination in humans can be confounded by the immunocompetence of the vaccinee, diverse and unknown previous influenza immunisations and virulence and transmissibility of influenza virus strains 12,16,25 . Our study focused on the immune responses to repeated H3N2 exposure which has been circulating since 1968 and has evolved since then 26 .…”

Section: Discussionmentioning

confidence: 99%

“…Repeated once‐annual vaccination with surface HA proteins which are relatively similar can limit antibody boosting, known as the antigenic distance hypothesis 15 . Repeated vaccination may even reduce seasonal vaccine efficacy, with reports of higher rates of protection in individuals that were not vaccinated in the previous year compared to those who were, 16,17 especially when the vaccine strains are maintained between yearly vaccine formulations and only a minor antigen drift has occurred in circulating strains, as this can impact the ability of the individual to respond to new strain during infection.…”

Section: Introductionmentioning

confidence: 99%

Repeated influenza vaccination provides cumulative protection from distinct H3N2 viruses

2021

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Objectives Current inactivated influenza vaccines provide suboptimal protection against antigenic drift, and repeated annual vaccinations shape antibody specificity but the effect on protection from infection is not well understood. Methods We studied the effects of cumulative and staggered vaccinations in mice to determine the effect of influenza vaccination on protection from infection and immune quality. Results We found that the timing of vaccination and antigenic change impacted the quality of immune responses. When mice received two different H3N2 strains (A/Hong Kong/4801/2014 and A/Singapore/INFIMH‐16‐0019/2016) by staggered timing of vaccination, there were higher H3HA antibody and B‐cell memory responses than four cumulative vaccinations or when two vaccinations were successive. Interestingly, after challenge with a lethal‐drifted H3N2 virus (A/Hong Kong/1/1968), mice with staggered vaccination were unable to produce high titres of antibodies specific to the challenge strain compared to other vaccination regimens because of high levels of vaccine‐specific cross‐reactive antibodies. All vaccination regimens resulted in protection, in terms of viral loads and survival, from lethal challenge, while lung IL‐6 and inflammation were lowest in staggered or cumulative vaccination groups, indicating further advantage. Conclusion Our findings help justify influenza vaccination policies that currently recommend repeat vaccination in infants and annual seasonal vaccination, with no evidence for impaired immunity by repeated seasonal vaccination.

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“…The pattern of decreasing VE as age increases may suggest a role of immune history in shaping the vaccine response. There are evidences suggesting that repeated vaccination impacts vaccine protection against influenza virus, which might consequently alter VE estimates [31,32]. The underlying immunologic mechanisms for the potential vaccine interference are not well understood [33].…”

Section: Plos Onementioning

confidence: 99%

Inactivated influenza vaccine effectiveness among department of defense beneficiaries aged 6 months-17 years, 2016–2017 through 2019–2020 influenza seasons

DeMarcus

Sjoberg

et al. 2021

PLoS ONE

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A test-negative case-control study was conducted to assess inactivated influenza vaccine effectiveness (VE) in children aged 6 months-17 years. The database was developed from the US Department of Defense Global Respiratory Pathogen Surveillance Program over four consecutive influenza seasons from 2016 to 2020. A total of 9,385 children including 4,063 medically attended, laboratory-confirmed influenza-positive cases were identified for VE analysis. A generalized linear mixed model with logit link and binomial distribution was used to estimate the VE. The adjusted VE for children was 42% [95% confidence interval (CI): 37–47%] overall, including 55% (95% CI: 47–61%) for influenza A(H1N1)pdm09, 37% (95% CI: 28–45%) for influenza A(H3N2), and 49% (95% CI: 41–55%) for influenza B. The analysis by age groups indicated that the adjusted VE in children aged 6 months-4 years was higher against influenza A(H1N1)pdm09 and influenza B, and comparable against influenza A(H3N2), compared to those in children aged 5–17 years. Further age-stratified analysis showed that the VE against any types of influenza was low and non-significant for children aged 6–11 months (33%; 95% CI:-2-56%), but it was high (54%; 95% CI: 34–67%) in children aged 12–23 months, and then declined linearly with increasing age. In conclusion, the inactivated influenza vaccination was moderately effective against influenza infection, based on the analysis from a large number of children aged 6 months-17 years over multiple influenza seasons.

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The impact of repeated vaccination using 10-year vaccination history on protection against influenza in older adults: a test-negative design study across the 2010/11 to 2015/16 influenza seasons in Ontario, Canada

Cited by 20 publications

References 27 publications

Simple models to include influenza vaccination history when evaluating the effect of influenza vaccination

Simple models to include influenza vaccination history when evaluating the effect of influenza vaccination

Repeated influenza vaccination provides cumulative protection from distinct H3N2 viruses

Inactivated influenza vaccine effectiveness among department of defense beneficiaries aged 6 months-17 years, 2016–2017 through 2019–2020 influenza seasons

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