tetano
Editor, Senior Moderator
Am J Epidemiol. 2019 Nov 1. pii: kwz248. doi: 10.1093/aje/kwz248. [Epub ahead of print] [h=1]Influenza Vaccine Effectiveness in the Inpatient Setting; Evaluation of Potential Bias in the Test Negative Design by use of Alternate Control Groups.[/h]
Segaloff HE[SUP]1[/SUP], Cheng B[SUP]1[/SUP], Miller AV[SUP]1[/SUP], Petrie JG[SUP]1[/SUP], Malosh RE[SUP]1[/SUP], Cheng C[SUP]1[/SUP], Lauring AS[SUP]2,[/SUP][SUP]3[/SUP], Lamerato L[SUP]4[/SUP], Ferdinands JM[SUP]5[/SUP], Monto AS[SUP]1[/SUP], Martin ET[SUP]1[/SUP].
[h=3]Author information[/h] 1 Department of Epidemiology, University of Michigan School of Public Health, University of Michigan, Ann Arbor, Michigan. 2 Department of Internal Medicine, Division of Infectious Diseases, Michigan Medicine, University of Michigan, Ann Arbor, Michigan. 3 Department of Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan. 4 Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan. 5 Influenza Division, Centers for Disease Control and Prevention, Atlanta Georgia.
[h=3]Abstract[/h] The test negative design is validated in outpatient but not inpatient studies of influenza vaccine effectiveness. The prevalence of chronic pulmonary disease among inpatients may lead to nonrepresentative controls. Test negative design estimates are biased if vaccine administration is associated with incidence of non-influenza viruses. We evaluated whether control group selection and effects of vaccination on non-influenza viruses biased vaccine effectiveness in our study. Subjects were enrolled at the University of Michigan and Henry Ford hospitals during the 2014-15 and 2015-16 seasons. Patients presenting with acute respiratory infection were enrolled and tested for respiratory viruses. Vaccine effectiveness was estimated using three control groups: influenza negative, other respiratory virus positive, and pan-negative individuals; it was also estimated for other common respiratory viruses. In 2014-15, vaccine effectiveness was 41.1% (95% CI: 1.7%, 64.7%) using influenza negative, 24.5% (95% CI: -42.6%, 60.1%) using other-virus positive, and 45.8% (95% CI: 5.7%, 68.9%) using pan-negative controls. In 2015-16, vaccine effectiveness was 68.7% (95% CI: 44.6%, 82.5%) using influenza negative, 63.1% (95% CI: 25.0%, 82.2%) using other-virus positive, and 71.1% (46.2%, 84.8%) using pan-negative controls. Vaccination did not alter odds of other respiratory viruses. Results support use of the test negative design among inpatients.
? The Author(s) 2019. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
[h=4]KEYWORDS:[/h] Influenza; hospitalization; test negative design; vaccine effectiveness
PMID: 31673696 DOI: 10.1093/aje/kwz248
Segaloff HE[SUP]1[/SUP], Cheng B[SUP]1[/SUP], Miller AV[SUP]1[/SUP], Petrie JG[SUP]1[/SUP], Malosh RE[SUP]1[/SUP], Cheng C[SUP]1[/SUP], Lauring AS[SUP]2,[/SUP][SUP]3[/SUP], Lamerato L[SUP]4[/SUP], Ferdinands JM[SUP]5[/SUP], Monto AS[SUP]1[/SUP], Martin ET[SUP]1[/SUP].
[h=3]Author information[/h] 1 Department of Epidemiology, University of Michigan School of Public Health, University of Michigan, Ann Arbor, Michigan. 2 Department of Internal Medicine, Division of Infectious Diseases, Michigan Medicine, University of Michigan, Ann Arbor, Michigan. 3 Department of Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan. 4 Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan. 5 Influenza Division, Centers for Disease Control and Prevention, Atlanta Georgia.
[h=3]Abstract[/h] The test negative design is validated in outpatient but not inpatient studies of influenza vaccine effectiveness. The prevalence of chronic pulmonary disease among inpatients may lead to nonrepresentative controls. Test negative design estimates are biased if vaccine administration is associated with incidence of non-influenza viruses. We evaluated whether control group selection and effects of vaccination on non-influenza viruses biased vaccine effectiveness in our study. Subjects were enrolled at the University of Michigan and Henry Ford hospitals during the 2014-15 and 2015-16 seasons. Patients presenting with acute respiratory infection were enrolled and tested for respiratory viruses. Vaccine effectiveness was estimated using three control groups: influenza negative, other respiratory virus positive, and pan-negative individuals; it was also estimated for other common respiratory viruses. In 2014-15, vaccine effectiveness was 41.1% (95% CI: 1.7%, 64.7%) using influenza negative, 24.5% (95% CI: -42.6%, 60.1%) using other-virus positive, and 45.8% (95% CI: 5.7%, 68.9%) using pan-negative controls. In 2015-16, vaccine effectiveness was 68.7% (95% CI: 44.6%, 82.5%) using influenza negative, 63.1% (95% CI: 25.0%, 82.2%) using other-virus positive, and 71.1% (46.2%, 84.8%) using pan-negative controls. Vaccination did not alter odds of other respiratory viruses. Results support use of the test negative design among inpatients.
? The Author(s) 2019. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
[h=4]KEYWORDS:[/h] Influenza; hospitalization; test negative design; vaccine effectiveness
PMID: 31673696 DOI: 10.1093/aje/kwz248