Core_RT-PCR based Case-Control: Apt Measure of Influenza Vaccine Effectiveness

流感病毒在不断变化，疫苗每年都在重新配制。准确地估计 流感疫苗预防流感感染的有效性对于评估保护作用至关重要 由年度全国疫苗接种计划提供。发现更先进的策略来衡量 疫苗的有效性将有可能减少流感的总体负担，同时改善 人口我们计划用ACIP系统地评估流感疫苗的有效性 斯科特和白色地区6个月或6个月以上的人的推荐普遍免疫策略 医疗保健-寺庙人口研究区（SWH-TPRA）来源人口。我们的目标是利用我们的 独特的研究经验，探索目前的方法来衡量疫苗对实验室的有效性， 确认流感（VE-LCI），并确定、实施和评估创新、可行和可持续的 在门诊急症护理环境中测量所有6个月或以上患者VE-LCI的策略。我们 中心假设是，在美国，及时有效地测量VE-LCI是可行的和可持续的。 这一假设将通过追求三个具体目标进行检验：1）确定创新性，可行性和可持续性 为6个月或6个月以上的人及时有效地测量VE-LCI的策略 在门诊急性护理环境中护理急性呼吸道疾病（ARI），2）实施创新，可行 及时有效地测量6个月或以上儿童VE-LCI的可持续战略 在门诊急性护理环境中寻求对ARI的护理，以及3）评估创新性，可行性和可持续性 为6个月或以上寻求护理的人及时有效地测量VE-LCI的策略 急性呼吸道感染的患者为了实现这些目标，将在儿童中确定VE-LCI 年龄6个月- 18岁，成人年龄19-49岁和那些50岁或以上谁出席了SWH-TPRA 明确定义ARI聚集性且通过RT-PCR检测甲型或B型流感病毒呈阳性的门诊急症护理环境 通过比较他们接种流感疫苗的几率与年龄匹配的对照组， 流感病毒RT-PCR检测阴性，调整混杂因素后。2011-2012年至2015-2016年期间， 来自SWH-TPRA来源人群的人，在SWH患有PCP，并存在ARI群集 在流感流行期间，在SWH-TPRA门诊、急诊或急诊科， 将有资格参加这项CDC VE-LCI研究，采用滚动4小时区组招募策略 最小化选择偏差。采用RT-PCR证实的病例对照设计，我们将在所有患者中测量VE-LCI。 6个月或以上的人。将计算RT-PCR确认的流感疫苗接种率 病例和RT-PCR阴性对照，调整VE-LCI的混杂因素。这项研究具有创新性， 因为它将极大地帮助理解VE-LCI的及时和有效措施， 衡量扩大和增加流感免疫对疾病负担的公共卫生影响。

Influenza viruses are constantly changing and vaccines are reformulated every year. Accurately estimating influenza vaccine effectiveness to prevent influenza infection is critical in order to evaluate the protection provided by annual, nationwide vaccination programs. The discovery of more advanced strategies to measure vaccine effectiveness will potentially reduce the overall burden of influenza while improving the health of the population. We plan to systematically evaluate the effectiveness of influenza vaccines with the ACIP recommended universal immunization strategy for persons ages 6 months or older in the Scott and White Healthcare-Temple Population Research Area (SWH-TPRA) source population. Our objective is to use our singular research experience to explore current methodologies to measure vaccine effectiveness against lab- confirmed influenza (VE-LCI), and identify, implement and evaluate innovative, feasible, and sustainable strategies for measuring VE-LCI in all persons ages 6 months or older in outpatient acute care settings. Our central hypothesis is that timely and efficient measurement of VE-LCI is feasible and sustainable in the U.S. This hypothesis will be tested by pursuing three specific aims: 1) Identify innovative, feasible, and sustainable strategies to measure VE-LCI in a timely and efficient manner for persons of ages 6 months or older seeking care for an acute respiratory illness (ARI) in outpatient acute care settings, 2) Implement innovative, feasible and sustainable strategies to measure VE-LCI in a timely and efficient manner for persons 6 months or older seeking care for an ARI in outpatient acute care settings, and 3) Evaluate innovative, feasible and sustainable strategies to measure VE-LCI in a timely and efficient manner for persons 6 months or older seeking care for an ARI in outpatient acute care settings. To accomplish these goals, VE-LCI will be determined in children ages 6 months - 18 years, adults ages 19-49 years and those 50 years or older who present at SWH-TPRA outpatient acute care setting with a well-defined ARI cluster and test positive for influenza A or B by RT-PCR assay, by comparing their odds of being vaccinated against influenza with age-matched controls who had a negative influenza RT-PCR assay, after adjusting for confounders. During 2011-2012 through 2015-2016, persons from the SWH-TPRA source population, who have a PCP at SWH, and present with an ARI cluster during the influenza epidemic period at a SWH-TPRA outpatient clinic, urgent care or emergency department, will be eligible to participate in this CDC VE-LCI study, using a rolling 4 hour block recruitment strategy minimizing selection bias. Using RT-PCR confirmed case-control design, we will measure VE-LCI in all persons ages 6 months or older. Influenza immunization rates will be calculated for the RT-PCR confirmed cases and RT-PCR negative controls, adjusting VE-LCI for confounders. The proposed research is innovative, because it will greatly help understand timely and efficient measures of VE-LCI and will also define effective measures of the public health impact of expanded and increasing influenza immunization on burden of illness.