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Previous exposure to natural infection matters, Ulrike Baum - ESCAIDE 2018

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Register-based cohort studies to estimate influenza vaccine effectiveness.
THL, the National Institute of Finland
Project Funding:
Integrated Monitoring of Vaccines in Europe (I-MOVE+) This project has received funding from the European Union’s H2020 research and innovation programme under grant agreement No 634446.
Development of Robust and Innovative Vaccines Effectiveness (DRIVE) This work has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 777363. This Joint Undertaking receives support from the European Union’s Horizon 2020 research and innovation programme and EFPIA.

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Previous exposure to natural infection matters, Ulrike Baum - ESCAIDE 2018

  1. 1. PREVIOUS EXPOSURE TO NATURAL INFECTION MATTERS Ulrike Baum, Ritva Syrjänen, Kari Auranen, Niina Ikonen, Hanna Nohynek The effect of influenza A infection in 2016/17 on influenza A and B infection in 2017/18 in the Finnish elderly https://www.paivanlehti.fi/iskiko-flunssa-vai-influenssa-ja-kuinka-yskitaan-oikein/
  2. 2. DISCLOSURE  Conflict of Interest – None  Project Funding – Integrated Monitoring of Vaccines in Europe (I-MOVE+) This project has received funding from the European Union’s H2020 research and innovation programme under grant agreement No 634446. – Development of Robust and Innovative Vaccines Effectiveness (DRIVE) This work has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 777363. This Joint Undertaking receives support from the European Union’s Horizon 2020 research and innovation programme and EFPIA.  Travel Grant – Funding Initiative at ESCAIDE 2018 The effect of influenza A infection in 2016/17 on influenza A and B infection in 2017/18 in the Finnish elderly
  3. 3. RESEARCH QUESTION What happened to the more than 7000 elderly 2016/17 influenza A cases in the following season? The effect of influenza A infection in 2016/17 on influenza A and B infection in 2017/18 in the Finnish elderly https://ecdc.europa.eu/en/seasonal-influenza/season-2016-17
  4. 4. BACKGROUND  Register-based cohort studies to estimate influenza vaccine effectiveness  Acquired active immunity – Artificial through vaccination – Natural through infection  Exposure to natural infection very difficult to cover in large- scale observational studies The effect of influenza A infection in 2016/17 on influenza A and B infection in 2017/18 in the Finnish elderly
  5. 5. REGISTER-BASED COHORT STUDY  Elderly aged 65-100 years  Laboratory-confirmed influenza A in 2016/17  Laboratory-confirmed influenza A or B in 2017/18  Influenza vaccinations 2012/13-2017/18  Potential confounders Person Identifier Population Information System National Vaccination Register National Infectious Diseases Register Care Register for Health Care Register of Primary Health Care Visits The effect of influenza A infection in 2016/17 on influenza A and B infection in 2017/18 in the Finnish elderly Baum, U. et al. (2018) ‘Cohort study design for estimating the effectiveness of seasonal influenza vaccines in real time based on register data: The Finnish example’, Scandinavian Journal of Public Health. doi: 10.1177/1403494818808635.
  6. 6. BASELINE CHARACTERISTICS The effect of influenza A infection in 2016/17 on influenza A and B infection in 2017/18 in the Finnish elderly 0% 20% 40% 60% 80% 100% Relativefrequency 2016/17 influenza A cases (N=7407) Rest of the cohort (N=1,181,614)
  7. 7. 2017/18 INFLUENZA EPIDEMIC 0 200 400 600 800 40 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 20 Influenza A (7199 cases) Influenza B (5966 cases) 0% 25% 50% 75% 100% 40 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 20 Cumulative vaccination coverage The effect of influenza A infection in 2016/17 on influenza A and B infection in 2017/18 in the Finnish elderly 0 25 50 75 100 40 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 20 Influenza A (16 cases) Influenza B (146 cases) 0% 25% 50% 75% 100% 40 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 20 Cumulative vaccination coverage 2016/17 influenza A cases (N=7407) Rest of the cohort (N=1,181,614)
  8. 8. TIME-TO-EVENT ANALYSIS  Comparison of the influenza A, influenza B respectively, hazard rates in those who had a laboratory-confirmed influenza A infection in 2016/17 with the corresponding hazard rates in the rest of the cohort * adjusted for age, sex, presence of chronic diseases, number of hospitalisations in 2016, * influenza vaccination in 2017/18 and five previous seasons The effect of influenza A infection in 2016/17 on influenza A and B infection in 2017/18 in the Finnish elderly Outcome Hazard ratio* (95% confidence interval) Influenza A 0.20 (0.12; 0.33) Influenza B 2.48 (2.10; 2.93)
  9. 9. INTERPRETATION AND DISCUSSION  Residual immunity against influenza A  Replacement towards influenza B  Increased frailty of previous season’s influenza A cases  Impact on vaccine effectiveness estimates The effect of influenza A infection in 2016/17 on influenza A and B infection in 2017/18 in the Finnish elderly 0 0,5 1 1,5 2 2,5 3 3,5 Influenza A Influenza B Hazardratio
  10. 10. PREVIOUS EXPOSURE TO NATURAL INFECTION MATTERS Ulrike Baum, Ritva Syrjänen, Kari Auranen, Niina Ikonen, Hanna Nohynek The effect of influenza A infection in 2016/17 on influenza A and B infection in 2017/18 in the Finnish elderly https://www.paivanlehti.fi/iskiko-flunssa-vai-influenssa-ja-kuinka-yskitaan-oikein/

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