Effect of Antigenic Drift on Influenza Vaccine Effectiveness in the United States-2019-2020.
Effect of Antigenic Drift on Influenza Vaccine Effectiveness in the United States-2019-2020.
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DOI：
10.1093/cid/ciaa1884
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发表时间：
2021-12-06
期刊：
影响因子：
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通讯作者：
Flannery, Brendan
中科院分区：
文献类型：
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作者：
Tenforde, Mark W;Kondor, Rebecca J Garten;Flannery, Brendan
背景：在 2019-2020 流感季节开始时，人们担心全球新兴的 V1A.3 分支的流行 B/维多利亚病毒与疫苗中包含的毒株存在抗原性漂移。强烈的 B/Victoria 活动之后，遗传多样性 A(H1N1)pdm09 病毒也发生了抗原漂移的循环。我们在美国测量了针对这些新兴病毒引起的疾病的疫苗有效性 (VE)。方法：我们在 5 个地点招募了年龄≥6 个月的患有急性呼吸道疾病的门诊患者。通过逆转录酶聚合酶链反应（RT-PCR）对呼吸道标本进行流感检测。使用测试阴性设计，我们通过比较流感病例与测试阴性对照的疫苗接种几率，确定了病毒亚型/谱系和遗传亚支的流感 VE。 结果：在 8845 名参与者中，2722 人 (31%) 流感检测呈阳性，其中 1209 人 (44%) 为 B/Victoria，1405 人 (51%) 为 A(H1N1)pdm09。针对任何流感疾病的有效性为 39%（95% 置信区间 [CI]：32-44），针对 B/Victoria 的有效性为 45%（95% CI：37-52），针对 A(H1N1)pdm09 相关疾病的有效性为 30%（95% CI：21-39）。疫苗接种不能针对 A(H1N1)pdm09 病毒提供保护，该病毒具有抗原漂移进化枝 6B.1A 183P-5A+156K HA 基因（VE 7%；95% CI：-14 至 23%），该病毒在 1 月后占主导地位。结论：疫苗接种可以预防流感疾病，主要是由于 B/维多利亚病毒感染。由于抗原漂移病毒出现后季节末疫苗不匹配，针对 A(H1N1)pdm09 疾病的疫苗保护效果低于历史观察到的 40%-60%。漂移对疫苗保护的影响不容易预测，即使在漂移年份，也可以观察到显着的保护作用。
BACKGROUND: At the start of the 2019-2020 influenza season, concern arose that circulating B/Victoria viruses of the globally emerging clade V1A.3 were antigenically drifted from the strain included in the vaccine. Intense B/Victoria activity was followed by circulation of genetically diverse A(H1N1)pdm09 viruses that were also antigenically drifted. We measured vaccine effectiveness (VE) in the United States against illness from these emerging viruses.METHODS: We enrolled outpatients aged ≥6 months with acute respiratory illness at 5 sites. Respiratory specimens were tested for influenza by reverse-transcriptase polymerase chain reaction (RT-PCR). Using the test-negative design, we determined influenza VE by virus subtype/lineage and genetic subclades by comparing odds of vaccination in influenza cases versus test-negative controls.RESULTS: Among 8845 enrollees, 2722 (31%) tested positive for influenza, including 1209 (44%) for B/Victoria and 1405 (51%) for A(H1N1)pdm09. Effectiveness against any influenza illness was 39% (95% confidence interval [CI]: 32-44), 45% (95% CI: 37-52) against B/Victoria and 30% (95% CI: 21-39) against A(H1N1)pdm09-associated illness. Vaccination offered no protection against A(H1N1)pdm09 viruses with antigenically drifted clade 6B.1A 183P-5A+156K HA genes (VE 7%; 95% CI: -14 to 23%) which predominated after January.CONCLUSIONS: Vaccination provided protection against influenza illness, mainly due to infections from B/Victoria viruses. Vaccine protection against illness from A(H1N1)pdm09 was lower than historically observed effectiveness of 40%-60%, due to late-season vaccine mismatch following emergence of antigenically drifted viruses. The effect of drift on vaccine protection is not easy to predict and, even in drifted years, significant protection can be observed.