The potential effect of temporary immunity as a result of bias associated with healthy users and social determinants on observations of influenza vaccine effectiveness; could unmeasured confounding explain observed links between seasonal influenza vaccine and pandemic H1N1 infection?
Identifieur interne : 000420 ( Main/Exploration ); précédent : 000419; suivant : 000421The potential effect of temporary immunity as a result of bias associated with healthy users and social determinants on observations of influenza vaccine effectiveness; could unmeasured confounding explain observed links between seasonal influenza vaccine and pandemic H1N1 infection?
Auteurs : Natasha S. Crowcroft [Canada] ; Laura C. RosellaSource :
- BMC public health [ 1471-2458 ] ; 2012.
Descripteurs français
- KwdFr :
- Appréciation des risques (MeSH), Biais (épidémiologie) (MeSH), Canada (épidémiologie), Grippe humaine (prévention et contrôle), Grippe humaine (épidémiologie), Humains (MeSH), Pandémies (MeSH), Saisons (MeSH), Simulation numérique (MeSH), Sous-type H1N1 du virus de la grippe A (MeSH), Vaccination (statistiques et données numériques), Vaccins antigrippaux (administration et posologie), Vaccins antigrippaux (immunologie), État de santé (MeSH).
- MESH :
- administration et posologie : Vaccins antigrippaux.
- immunologie : Vaccins antigrippaux.
- prévention et contrôle : Grippe humaine.
- statistiques et données numériques : Vaccination.
- épidémiologie : Canada, Grippe humaine.
- Appréciation des risques, Biais (épidémiologie), Humains, Pandémies, Saisons, Simulation numérique, Sous-type H1N1 du virus de la grippe A, État de santé.
- Wicri :
- geographic : Canada.
English descriptors
- KwdEn :
- Bias (MeSH), Canada (epidemiology), Computer Simulation (MeSH), Confounding Factors, Epidemiologic (MeSH), Health Status (MeSH), Humans (MeSH), Influenza A Virus, H1N1 Subtype (MeSH), Influenza Vaccines (administration & dosage), Influenza Vaccines (immunology), Influenza, Human (epidemiology), Influenza, Human (prevention & control), Pandemics (MeSH), Risk Assessment (MeSH), Seasons (MeSH), Vaccination (statistics & numerical data).
- MESH :
- chemical , administration & dosage : Influenza Vaccines.
- geographic , epidemiology : Canada.
- chemical , immunology : Influenza Vaccines.
- epidemiology : Influenza, Human.
- prevention & control : Influenza, Human.
- statistics & numerical data : Vaccination.
- Bias, Computer Simulation, Confounding Factors, Epidemiologic, Health Status, Humans, Influenza A Virus, H1N1 Subtype, Pandemics, Risk Assessment, Seasons.
Abstract
BACKGROUND
Five observational studies from Canada found an association between seasonal influenza vaccine receipt and increased risk of pandemic influenza H1N1 2009 infection. This association remains unexplained. Although uncontrolled confounding has been suggested as a possible explanation, the nature of such confounding has not been identified. Observational studies of influenza vaccination can be affected by confounding due to healthy users and the influence of social determinants on health. The purpose of this study was to investigate the influence that these two potential confounders may have in combination with temporary immunity, using stratified tables. The hypothesis is that respiratory virus infections may activate a temporary immunity that provides short-term non-specific protection against influenza and that the relationship with being a healthy user or having a social determinant may result in confounding.
METHODS
We simulated the effect of confounding on vaccine effectiveness assuming that this could result from both social determinants and healthy user effects as they both influence the risk of seasonal influenza and non-influenza respiratory virus infections as well as the likelihood of being vaccinated. We then examined what impact this may have had on measurement of seasonal influenza vaccine effectiveness against pandemic influenza.
RESULTS
In this simulation, failure to adjust for healthy users and social determinants would result in an erroneously increased risk of pandemic influenza infection associated with seasonal influenza vaccination. The effect sizes were not however large.
CONCLUSIONS
We found that unmeasured healthy user effects and social determinants could result in an apparent association between seasonal influenza vaccine and pandemic influenza infection by virtue of being related to temporary immunity. Adjustment for social determinants of health and the healthy user effects are required in order to improve the quality of observational studies of influenza vaccine effectiveness.
DOI: 10.1186/1471-2458-12-458
PubMed: 22716096
PubMed Central: PMC3490826
Affiliations:
Links toward previous steps (curation, corpus...)
Le document en format XML
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<term>Canada (épidémiologie)</term>
<term>Grippe humaine (prévention et contrôle)</term>
<term>Grippe humaine (épidémiologie)</term>
<term>Humains (MeSH)</term>
<term>Pandémies (MeSH)</term>
<term>Saisons (MeSH)</term>
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<term>Sous-type H1N1 du virus de la grippe A (MeSH)</term>
<term>Vaccination (statistiques et données numériques)</term>
<term>Vaccins antigrippaux (administration et posologie)</term>
<term>Vaccins antigrippaux (immunologie)</term>
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<keywords scheme="MESH" qualifier="administration et posologie" xml:lang="fr"><term>Vaccins antigrippaux</term>
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<keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Influenza, Human</term>
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<keywords scheme="MESH" qualifier="immunologie" xml:lang="fr"><term>Vaccins antigrippaux</term>
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<term>Computer Simulation</term>
<term>Confounding Factors, Epidemiologic</term>
<term>Health Status</term>
<term>Humans</term>
<term>Influenza A Virus, H1N1 Subtype</term>
<term>Pandemics</term>
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<keywords scheme="MESH" xml:lang="fr"><term>Appréciation des risques</term>
<term>Biais (épidémiologie)</term>
<term>Humains</term>
<term>Pandémies</term>
<term>Saisons</term>
<term>Simulation numérique</term>
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<front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b>
</p>
<p>Five observational studies from Canada found an association between seasonal influenza vaccine receipt and increased risk of pandemic influenza H1N1 2009 infection. This association remains unexplained. Although uncontrolled confounding has been suggested as a possible explanation, the nature of such confounding has not been identified. Observational studies of influenza vaccination can be affected by confounding due to healthy users and the influence of social determinants on health. The purpose of this study was to investigate the influence that these two potential confounders may have in combination with temporary immunity, using stratified tables. The hypothesis is that respiratory virus infections may activate a temporary immunity that provides short-term non-specific protection against influenza and that the relationship with being a healthy user or having a social determinant may result in confounding.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>METHODS</b>
</p>
<p>We simulated the effect of confounding on vaccine effectiveness assuming that this could result from both social determinants and healthy user effects as they both influence the risk of seasonal influenza and non-influenza respiratory virus infections as well as the likelihood of being vaccinated. We then examined what impact this may have had on measurement of seasonal influenza vaccine effectiveness against pandemic influenza.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>RESULTS</b>
</p>
<p>In this simulation, failure to adjust for healthy users and social determinants would result in an erroneously increased risk of pandemic influenza infection associated with seasonal influenza vaccination. The effect sizes were not however large.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b>
</p>
<p>We found that unmeasured healthy user effects and social determinants could result in an apparent association between seasonal influenza vaccine and pandemic influenza infection by virtue of being related to temporary immunity. Adjustment for social determinants of health and the healthy user effects are required in order to improve the quality of observational studies of influenza vaccine effectiveness.</p>
</div>
</front>
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