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Background <p>The Influenza – Monitoring Vaccine Effectiveness in Europe (I-MOVE/I-MOVE+) and Vaccine Effectiveness, Burden and Impact Studies (VEBIS) hospital networks have conducted seasonal multicentre, test-negative, case–control studies in Europe to measure influenza vaccine effectiveness (IVE) since 2015/16. We measured the effect of chronic conditions on VE of influenza A subtypes among older adults (≥ 65&#xa0;years) using pooled-season data (2015/16–2023/24).</p> Methods <p>Hospital teams swabbed patients with severe acute respiratory infection (SARI) within 7&#xa0;days of symptom onset. Cases were RT-PCR positive for influenza A(H1N1)pdm09 or A(H3N2); controls negative for any influenza virus. We calculated overall pooled-season IVE against influenza A(H1N1)pdm09 and A(H3N2), adjusted for study site, sex, age and onset date; and stratified by number of and by each chronic condition (diabetes, heart disease, lung disease/asthma, immunosuppression, kidney disease, liver disease, cancer, obesity). We investigated interaction between vaccination and each condition.</p> Results <p>We included 1805 A(H1N1)pdm09 cases with 16,329 controls; 2590 A(H3N2) cases with 14,920 controls, from 13 study sites (12 countries). Over all seasons, 63–67% cases and 70% controls had ≥ 2 chronic conditions.</p> <p>Against A(H1N1)pdm09, pooled-season IVE was 37% (95%CI: 29–44) overall; 49% (95%CI: 9–72), 30% (95%CI: 12–44) and 38% (95%CI: 29–46) in those with 0, 1, ≥ 2&#xa0;chronic conditions. Most IVE point estimates were 34–45%, apart from immunosuppression (-7%), kidney disease (17%) and liver disease (54%), but 95% CIs overlapped. Significant interaction was observed for kidney disease (<i>p</i> = 0.02) and immunosuppression (<i>p</i> = 0.01). Against A(H3N2), pooled-season IVE was 17% (95%CI: 8–25) overall; 15% (95%CI: -26–42), 11% (95%CI: -8–27) and 18% (95%CI: 7–28) in those with 0, 1, ≥ 2 chronic conditions. Here, IVE point estimates ranged 13–25%, apart from immunosuppression (5%), kidney disease (6%) and liver disease (31%), although 95% CIs overlapped. There were no significant interactions.</p> Conclusions <p>Pooled-season results suggest low–moderate VE against influenza A subtypes among older SARI patients; higher against A(H1N1)pdm09 than A(H3N2), with little evidence of chronic condition modifying effect, apart from kidney disease and immunosuppression. We stress the importance of developing improved influenza vaccines for specific populations, and encourage further research into the effect of chronic conditions on IVE in older adults.</p>

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Vaccine effectiveness against influenza A in older adults and the effect of chronic conditions: results from the I-MOVE and VEBIS multicentre European hospital case–control studies, 2015/16–2023/24

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  • 发表日期：

    2025年11月3日

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  • Angela Mary Catherine Rose,
  • Nathalie Nicolay,
  • Clara Mazagatos,
  • Iván Martínez-Baz,
  • Odile Launay,
  • Laurane De Mot,
  • Antonino Bella,
  • Mihaela Lazar,
  • Ausenda Machado,
  • Monika Kuliešė,
  • Stephen Abela,
  • Vesna Višekruna Vučina,
  • Rianne van Gageldonk-Lafeber,
  • Silvia Bino,
  • Ralf  Dürrwald,
  • Iwona Paradowska-Stankiewicz,
  • Judit Krisztina Horváth,
  • Róisín Duffy,
  • Petr Husa,
  • Jim McMenamin,
  • Francisco Pozo,
  • Jennifer Howard,
  • Miriam Latorre-Millán,
  • Jesús Castilla,
  • Liem Binh Luong Nguyen,
  • Nicolas Dauby,
  • Flavia Riccardo,
  • Alina Ivanciuc,
  • Verónica Gomez,
  • Ligita Jančorienė,
  • Gerd Xuereb,
  • Goranka Petrović,
  • Sierk Marbus,
  • Adela Vasili,
  • Kristin Tolksdorf,
  • Joanna Bogusz,
  • Beatrix Oroszi,
  • Lisa Domegan,
  • Lenka Součková,
  • Kimberley Marsh,
  • Sabrina Bacci,
  • Esther Kissling,
  • Francesco Genderini,
  • Sigi Van Den Wijngaert,
  • Gabriella Kollár,
  • Bernard Kaić,
  • Sanja Kurečić Filipović,
  • Iva Pem Novosel,
  • Zvjezdana Lovrić Makarić,
  • Martina Zajec,
  • Maja Ilić,
  • Ivan Mlinarić,
  • Irena Tabain,
  • Petra Smoljo,
  • Barbara Biere,
  • Silke Buda,
  • Annika Erdwiens,
  • Carolin Hackmann,
  • Ute Preuß,
  • Janine Reiche,
  • Marianne Wedde,
  • Annamária Ferenczi,
  • Krisztina M. Juhász,
  • Gergő Túri,
  • Viktória Velkey,
  • Katalin Kristóf,
  • Bánk G. Fenyves,
  • Csaba Varga,
  • Márta Knausz,
  • Bernadett Burkali,
  • Margaret Fitzgerald,
  • Terra Fatukasi,
  • Joan O’Donnell,
  • Charlene Bennett,
  • Jeff O’Connell,
  • Marcos Lozano,
  • Gloria Pérez-Gimeno,
  • Ana Milagro,
  • Alberto M. Urdiales,
  • Roberta Vaikutyte-Ramanauskiene,
  • Aukse Mickiene,
  • Birute Zablockiene,
  • Giedre Gefenaite,
  • Ana Navascués,
  • Ana Miqueleiz,
  • Miguel Fernández-Huerta,
  • Carmen Ezpeleta,
  • Aitziber Echeverria,
  • Camino Trobajo-Sanmartín,
  • Itziar Casado,
  • Nerea Egüés,
  • Manuel G. Cenoz,
  • Cristina Burgui,
  • Guillermo Ezpeleta,
  • Ana Paula Rodrigues,
  • Nuno Verdasca,
  • Licínia Gomes,
  • Daniela Dias,
  • Raquel Guiomar,
  • Victor Gomes,
  • António Panarra,
  • Liliana Dias,
  • André Almeida,
  • Heidi Gruner,
  • Rita Côrte-Real,
  • Paula Lopes,
  • Maria João Peres,
  • José Poças,
  • Débora Pereira,
  • Margarida Tavares,
  • Paula Pinto,
  • António Pais de Lacerda,
  • Cristina Bárbara,
  • Isabela I. Loghin,
  • Corneliu Popescu,
  • Silvia-Odette Popovici

摘要

Background

The Influenza – Monitoring Vaccine Effectiveness in Europe (I-MOVE/I-MOVE+) and Vaccine Effectiveness, Burden and Impact Studies (VEBIS) hospital networks have conducted seasonal multicentre, test-negative, case–control studies in Europe to measure influenza vaccine effectiveness (IVE) since 2015/16. We measured the effect of chronic conditions on VE of influenza A subtypes among older adults (≥ 65 years) using pooled-season data (2015/16–2023/24).

Methods

Hospital teams swabbed patients with severe acute respiratory infection (SARI) within 7 days of symptom onset. Cases were RT-PCR positive for influenza A(H1N1)pdm09 or A(H3N2); controls negative for any influenza virus. We calculated overall pooled-season IVE against influenza A(H1N1)pdm09 and A(H3N2), adjusted for study site, sex, age and onset date; and stratified by number of and by each chronic condition (diabetes, heart disease, lung disease/asthma, immunosuppression, kidney disease, liver disease, cancer, obesity). We investigated interaction between vaccination and each condition.

Results

We included 1805 A(H1N1)pdm09 cases with 16,329 controls; 2590 A(H3N2) cases with 14,920 controls, from 13 study sites (12 countries). Over all seasons, 63–67% cases and 70% controls had ≥ 2 chronic conditions.

Against A(H1N1)pdm09, pooled-season IVE was 37% (95%CI: 29–44) overall; 49% (95%CI: 9–72), 30% (95%CI: 12–44) and 38% (95%CI: 29–46) in those with 0, 1, ≥ 2 chronic conditions. Most IVE point estimates were 34–45%, apart from immunosuppression (-7%), kidney disease (17%) and liver disease (54%), but 95% CIs overlapped. Significant interaction was observed for kidney disease (p = 0.02) and immunosuppression (p = 0.01). Against A(H3N2), pooled-season IVE was 17% (95%CI: 8–25) overall; 15% (95%CI: -26–42), 11% (95%CI: -8–27) and 18% (95%CI: 7–28) in those with 0, 1, ≥ 2 chronic conditions. Here, IVE point estimates ranged 13–25%, apart from immunosuppression (5%), kidney disease (6%) and liver disease (31%), although 95% CIs overlapped. There were no significant interactions.

Conclusions

Pooled-season results suggest low–moderate VE against influenza A subtypes among older SARI patients; higher against A(H1N1)pdm09 than A(H3N2), with little evidence of chronic condition modifying effect, apart from kidney disease and immunosuppression. We stress the importance of developing improved influenza vaccines for specific populations, and encourage further research into the effect of chronic conditions on IVE in older adults.