Estimates of Influenza Vaccine Effectiveness

描述（由研究者提供）：流感疫苗是最广泛使用的流感控制措施，但在许多高危人群中缺乏对实验室确认的流感疫苗有效性的估计。此外，在许多人群中，抗原变异与疫苗有效性之间的关系尚不完全清楚。我们认识上的这些差距阻碍了有效使用流感疫苗的努力，并使从业人员对疫苗在某些人群（特别是老年人）中的效用产生了怀疑。拟议的研究将采用病例对照方法来评估流感疫苗在预防经实验室确认的经医疗护理的急性呼吸道疾病方面的有效性。作为住院病人、急诊科和门诊就诊的个人将接受各种呼吸道病毒的检测，并将流感阳性病例的疫苗接种史与呼吸道合胞病毒、人偏肺病毒或鼻病毒阳性的对照组进行比较。将对两大人群进行评估：6个月至13岁的儿童和50岁及以上的成年人。逻辑回归和Cox比例风险模型将被用来在调整了一些协变量后确定有效性。该分析的一个关键特征将是检测其他呼吸道病毒以确定控制，从而避免由于诊断检测可能不准确而导致病例错误分类的问题。此外，我们将在流感疫苗接种前后获取健康年轻人和老年人的外周血，以评估可能与所见保护效果程度相关的体液和细胞免疫反应。该应用程序利用了罗切斯特大学存在的几个强大的协同项目，包括新疫苗监测网络（NVSN）、新发感染项目（EIP）和纽约流感卓越中心（NYICE）。这些研究的成功完成将有助于深入了解流感疫苗在不同目标群体中的效用，抗原变异与疫苗效果之间的关系，以及免疫反应性与有效性之间的关系。

DESCRIPTION (provided by investigator): Influenza vaccine is the most widely used control measure for influenza, but estimates of the effectiveness of vaccine against laboratory confirmed influenza are lacking in many high risk populations. In addition, the relationship between antigenic variation and vaccine effectiveness is incompletely understood in many populations. These gaps in our understanding hinder efforts to use influenza vaccines effectively, and have generated doubts among practitioners regarding the utility of vaccine in some populations, notably the elderly. The proposed studies will use a case control approach to assess the effectiveness of influenza vaccine in preventing laboratory-confirmed medically attended acute respiratory illness. Individuals seeking care as inpatients, in emergency departments, and in outpatient clinics will be tested for the presence of a variety of respiratory viruses, and vaccination histories in influenza positive cases will be compared with controls who are positive for respiratory syncytial virus, human metapneumovirus, or rhinovirus. Two broad populations will be assessed: children from 6 months of age to 13 years, and adults 50 years of age and older. Both logistic regression and Cox proportional hazard models will be utilized to determine effectiveness after adjusting for a number of covariates. A key feature of the analysis will be the detection of other respiratory viruses to identify controls, which avoids the problem of misclassification of cases due to possible inaccuracies in diagnostic testing. In addition, we will obtain peripheral blood from healthy young adults and elderly adults before and after influenza vaccination for assessment of humoral and cellular immune responses that may be related to the degree of protective efficacy seen. The application takes advantage of the existence of several strong, synergistic programs at the University of Rochester, including the New Vaccines Surveillance Network (NVSN), the Emerging Infections Program (EIP), and the New York Influenza Center of Excellence (NYICE). Successful completion of these studies will provide insight into the utility of influenza vaccine in various target groups, the relationship between antigenic variation and vaccine effect, and between immune responsiveness and effectiveness.