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Effectiveness of Live Attenuated vs Inactivated Influenza Vaccines in Children During the 2012-2013 Through 2015-2016 Influenza Seasons in Alberta, Canada: A Canadian Immunization Research Network (CIRN) Study.

Identifieur interne : 000055 ( Main/Exploration ); précédent : 000054; suivant : 000056

Effectiveness of Live Attenuated vs Inactivated Influenza Vaccines in Children During the 2012-2013 Through 2015-2016 Influenza Seasons in Alberta, Canada: A Canadian Immunization Research Network (CIRN) Study.

Auteurs : Sarah A. Buchan [Canada] ; Stephanie Booth [Canada] ; Allison N. Scott [Canada] ; Kimberley A. Simmonds [Canada] ; Lawrence W. Svenson [Canada] ; Steven J. Drews [Canada] ; Margaret L. Russell [Canada] ; Natasha S. Crowcroft [Canada] ; Mark Loeb [Canada] ; Bryna F. Warshawsky [Canada] ; Jeffrey C. Kwong [Canada]

Source :

RBID : pubmed:29971427

Descripteurs français

English descriptors

Abstract

Importance

Recent observational studies report conflicting results regarding the effectiveness of live attenuated influenza vaccine (LAIV), particularly against influenza A(H1N1)pdm09.

Objective

To compare the effectiveness of LAIV and inactivated influenza vaccine (IIV) against laboratory-confirmed influenza.

Design, Setting, and Participants

A test-negative study to estimate influenza vaccine effectiveness (VE) using population-based, linked, individual-level laboratory, health administrative, and immunization data. Data were obtained from 10 169 children and adolescents aged 2 to 17 years (children) who were tested for influenza in inpatient or outpatient settings during periods when influenza was circulating based on a threshold level of 5% weekly test positivity for the province during the 4 influenza seasons spanning from November 11, 2012, to April 30, 2016, in Alberta, Canada. Logistic regression was used to estimate VE by vaccine type, influenza season, and influenza type and subtype. The relative effectiveness of each vaccine type was assessed by comparing the odds of laboratory-confirmed influenza infection for LAIV recipients with that for IIV recipients.

Exposures

The primary exposure was receipt of LAIV or IIV before testing for influenza.

Main Outcomes and Measures

The primary outcome was influenza case status as determined by reverse-transcriptase polymerase chain reaction testing.

Results

A total of 10 779 respiratory specimens (from 10 169 children) collected and tested for influenza during the 4 influenza seasons were included, with 53.4% from males; the mean (SD) age was 7.0 (4.6) years. Across the 4 influenza seasons, 3161 children tested positive for influenza. Combining the 4 influenza seasons, the adjusted VE against influenza A(H1N1)pdm09 was 69% (95% CI, 56%-78%) for LAIV compared with 79% (95% CI, 70%-86%) for IIV. Vaccine effectiveness against influenza A(H3N2) was 36% (95% CI, 14%-53%) for LAIV and 43% (95% CI, 22%-59%) for IIV. Against influenza B, VE was 74% (95% CI, 62%-82%) for LAIV and 56% (95% CI, 41%-66%) for IIV. There were no significant differences in the odds of influenza infection for LAIV recipients compared with IIV recipients except for influenza B during the 2015-2016 season, when LAIV recipients had lower odds of infection than IIV recipients (odds ratio, 0.36; 95% CI, 0.17-0.76).

Conclusions and Relevance

There was no evidence to support the lack of effectiveness of LAIV against influenza A(H1N1)pdm09. These results support administration of either vaccine type in this age group.


DOI: 10.1001/jamapediatrics.2018.1514
PubMed: 29971427


Affiliations:


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Le document en format XML

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<nlm:affiliation>Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.</nlm:affiliation>
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<nlm:affiliation>Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.</nlm:affiliation>
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<nlm:affiliation>Toronto Western Family Health Team, University Health Network, Toronto, Ontario, Canada.</nlm:affiliation>
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<title level="j">JAMA pediatrics</title>
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<term>Adolescent</term>
<term>Alberta</term>
<term>Child</term>
<term>Child, Preschool</term>
<term>Female</term>
<term>Humans</term>
<term>Influenza A Virus, H1N1 Subtype</term>
<term>Influenza A Virus, H3N2 Subtype</term>
<term>Influenza Vaccines (administration & dosage)</term>
<term>Influenza, Human (epidemiology)</term>
<term>Influenza, Human (prevention & control)</term>
<term>Influenza, Human (virology)</term>
<term>Male</term>
<term>Seasons</term>
<term>Vaccination (statistics & numerical data)</term>
<term>Vaccines, Attenuated (administration & dosage)</term>
<term>Vaccines, Inactivated (administration & dosage)</term>
</keywords>
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<term>Adolescent</term>
<term>Alberta</term>
<term>Enfant</term>
<term>Enfant d'âge préscolaire</term>
<term>Femelle</term>
<term>Grippe humaine ()</term>
<term>Grippe humaine (virologie)</term>
<term>Grippe humaine (épidémiologie)</term>
<term>Humains</term>
<term>Mâle</term>
<term>Saisons</term>
<term>Sous-type H1N1 du virus de la grippe A</term>
<term>Sous-type H3N2 du virus de la grippe A</term>
<term>Vaccination ()</term>
<term>Vaccins antigrippaux (administration et posologie)</term>
<term>Vaccins atténués (administration et posologie)</term>
<term>Vaccins inactivés (administration et posologie)</term>
</keywords>
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<term>Influenza Vaccines</term>
<term>Vaccines, Attenuated</term>
<term>Vaccines, Inactivated</term>
</keywords>
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<term>Alberta</term>
</keywords>
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<term>Vaccins antigrippaux</term>
<term>Vaccins atténués</term>
<term>Vaccins inactivés</term>
</keywords>
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<term>Influenza, Human</term>
</keywords>
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<term>Influenza, Human</term>
</keywords>
<keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en">
<term>Vaccination</term>
</keywords>
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<term>Grippe humaine</term>
</keywords>
<keywords scheme="MESH" qualifier="virology" xml:lang="en">
<term>Influenza, Human</term>
</keywords>
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<term>Grippe humaine</term>
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<term>Adolescent</term>
<term>Child</term>
<term>Child, Preschool</term>
<term>Female</term>
<term>Humans</term>
<term>Influenza A Virus, H1N1 Subtype</term>
<term>Influenza A Virus, H3N2 Subtype</term>
<term>Male</term>
<term>Seasons</term>
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<term>Adolescent</term>
<term>Alberta</term>
<term>Enfant</term>
<term>Enfant d'âge préscolaire</term>
<term>Femelle</term>
<term>Grippe humaine</term>
<term>Humains</term>
<term>Mâle</term>
<term>Saisons</term>
<term>Sous-type H1N1 du virus de la grippe A</term>
<term>Sous-type H3N2 du virus de la grippe A</term>
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<div type="abstract" xml:lang="en">
<p>
<b>Importance</b>
</p>
<p>Recent observational studies report conflicting results regarding the effectiveness of live attenuated influenza vaccine (LAIV), particularly against influenza A(H1N1)pdm09.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>Objective</b>
</p>
<p>To compare the effectiveness of LAIV and inactivated influenza vaccine (IIV) against laboratory-confirmed influenza.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>Design, Setting, and Participants</b>
</p>
<p>A test-negative study to estimate influenza vaccine effectiveness (VE) using population-based, linked, individual-level laboratory, health administrative, and immunization data. Data were obtained from 10 169 children and adolescents aged 2 to 17 years (children) who were tested for influenza in inpatient or outpatient settings during periods when influenza was circulating based on a threshold level of 5% weekly test positivity for the province during the 4 influenza seasons spanning from November 11, 2012, to April 30, 2016, in Alberta, Canada. Logistic regression was used to estimate VE by vaccine type, influenza season, and influenza type and subtype. The relative effectiveness of each vaccine type was assessed by comparing the odds of laboratory-confirmed influenza infection for LAIV recipients with that for IIV recipients.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>Exposures</b>
</p>
<p>The primary exposure was receipt of LAIV or IIV before testing for influenza.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>Main Outcomes and Measures</b>
</p>
<p>The primary outcome was influenza case status as determined by reverse-transcriptase polymerase chain reaction testing.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>Results</b>
</p>
<p>A total of 10 779 respiratory specimens (from 10 169 children) collected and tested for influenza during the 4 influenza seasons were included, with 53.4% from males; the mean (SD) age was 7.0 (4.6) years. Across the 4 influenza seasons, 3161 children tested positive for influenza. Combining the 4 influenza seasons, the adjusted VE against influenza A(H1N1)pdm09 was 69% (95% CI, 56%-78%) for LAIV compared with 79% (95% CI, 70%-86%) for IIV. Vaccine effectiveness against influenza A(H3N2) was 36% (95% CI, 14%-53%) for LAIV and 43% (95% CI, 22%-59%) for IIV. Against influenza B, VE was 74% (95% CI, 62%-82%) for LAIV and 56% (95% CI, 41%-66%) for IIV. There were no significant differences in the odds of influenza infection for LAIV recipients compared with IIV recipients except for influenza B during the 2015-2016 season, when LAIV recipients had lower odds of infection than IIV recipients (odds ratio, 0.36; 95% CI, 0.17-0.76).</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>Conclusions and Relevance</b>
</p>
<p>There was no evidence to support the lack of effectiveness of LAIV against influenza A(H1N1)pdm09. These results support administration of either vaccine type in this age group.</p>
</div>
</front>
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<Month>10</Month>
<Day>08</Day>
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<Year>2019</Year>
<Month>10</Month>
<Day>08</Day>
</DateRevised>
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<Journal>
<ISSN IssnType="Electronic">2168-6211</ISSN>
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<Volume>172</Volume>
<Issue>9</Issue>
<PubDate>
<Year>2018</Year>
<Month>09</Month>
<Day>01</Day>
</PubDate>
</JournalIssue>
<Title>JAMA pediatrics</Title>
<ISOAbbreviation>JAMA Pediatr</ISOAbbreviation>
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<ArticleTitle>Effectiveness of Live Attenuated vs Inactivated Influenza Vaccines in Children During the 2012-2013 Through 2015-2016 Influenza Seasons in Alberta, Canada: A Canadian Immunization Research Network (CIRN) Study.</ArticleTitle>
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<Abstract>
<AbstractText Label="Importance">Recent observational studies report conflicting results regarding the effectiveness of live attenuated influenza vaccine (LAIV), particularly against influenza A(H1N1)pdm09.</AbstractText>
<AbstractText Label="Objective">To compare the effectiveness of LAIV and inactivated influenza vaccine (IIV) against laboratory-confirmed influenza.</AbstractText>
<AbstractText Label="Design, Setting, and Participants">A test-negative study to estimate influenza vaccine effectiveness (VE) using population-based, linked, individual-level laboratory, health administrative, and immunization data. Data were obtained from 10 169 children and adolescents aged 2 to 17 years (children) who were tested for influenza in inpatient or outpatient settings during periods when influenza was circulating based on a threshold level of 5% weekly test positivity for the province during the 4 influenza seasons spanning from November 11, 2012, to April 30, 2016, in Alberta, Canada. Logistic regression was used to estimate VE by vaccine type, influenza season, and influenza type and subtype. The relative effectiveness of each vaccine type was assessed by comparing the odds of laboratory-confirmed influenza infection for LAIV recipients with that for IIV recipients.</AbstractText>
<AbstractText Label="Exposures">The primary exposure was receipt of LAIV or IIV before testing for influenza.</AbstractText>
<AbstractText Label="Main Outcomes and Measures">The primary outcome was influenza case status as determined by reverse-transcriptase polymerase chain reaction testing.</AbstractText>
<AbstractText Label="Results">A total of 10 779 respiratory specimens (from 10 169 children) collected and tested for influenza during the 4 influenza seasons were included, with 53.4% from males; the mean (SD) age was 7.0 (4.6) years. Across the 4 influenza seasons, 3161 children tested positive for influenza. Combining the 4 influenza seasons, the adjusted VE against influenza A(H1N1)pdm09 was 69% (95% CI, 56%-78%) for LAIV compared with 79% (95% CI, 70%-86%) for IIV. Vaccine effectiveness against influenza A(H3N2) was 36% (95% CI, 14%-53%) for LAIV and 43% (95% CI, 22%-59%) for IIV. Against influenza B, VE was 74% (95% CI, 62%-82%) for LAIV and 56% (95% CI, 41%-66%) for IIV. There were no significant differences in the odds of influenza infection for LAIV recipients compared with IIV recipients except for influenza B during the 2015-2016 season, when LAIV recipients had lower odds of infection than IIV recipients (odds ratio, 0.36; 95% CI, 0.17-0.76).</AbstractText>
<AbstractText Label="Conclusions and Relevance">There was no evidence to support the lack of effectiveness of LAIV against influenza A(H1N1)pdm09. These results support administration of either vaccine type in this age group.</AbstractText>
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<LastName>Buchan</LastName>
<ForeName>Sarah A</ForeName>
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<Affiliation>Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>Primary Care & Population Health Research Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.</Affiliation>
</AffiliationInfo>
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</AffiliationInfo>
<AffiliationInfo>
<Affiliation>Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.</Affiliation>
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</AffiliationInfo>
<AffiliationInfo>
<Affiliation>Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.</Affiliation>
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</AffiliationInfo>
<AffiliationInfo>
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<ForeName>Natasha S</ForeName>
<Initials>NS</Initials>
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<Affiliation>Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>Applied Immunization Research and Evaluation, Public Health Ontario, Toronto, Ontario, Canada.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.</Affiliation>
</AffiliationInfo>
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<LastName>Loeb</LastName>
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</AffiliationInfo>
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<AffiliationInfo>
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<AffiliationInfo>
<Affiliation>Primary Care & Population Health Research Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>Applied Immunization Research and Evaluation, Public Health Ontario, Toronto, Ontario, Canada.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>Toronto Western Family Health Team, University Health Network, Toronto, Ontario, Canada.</Affiliation>
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