Respiratory pathogen surveillance trends and influenza vaccine effectiveness estimates for the 2018-2019 season among Department of Defense beneficiaries.

This report primarily focuses on the data collected and analyzed from the worldwide network of sentinel military treatment facilities chosen to participate in the Department of Defense Global Respiratory Pathogen Surveillance (DoDGRS) program. Sites that participated in the 2018-2019 DoDGRS program submitted 24,320 respiratory specimens for diagnostic testing. Clinical results showed a total of 5,968 positive influenza cases. In the beginning of the season, starting in surveillance week 48, influenza A(H1N1)pdm09 was the predominant subtype. The predominant subtype switched to influenza A(H3N2) beginning in week 6 and continued through the end of the season. Influenza B virus detection was less common during the surveillance period (i.e., 1% of total submitted specimens and 5% of total influenza detected). In addition to routine surveillance, the DoDGRS program also conducts vaccine effectiveness (VE) studies twice per year to determine interim and end of season estimates. Overall, the adjusted end of season VE for all dependents regardless of influenza type was 30% (95% CI: 22%-38%).

Live Attenuated and Inactivated Influenza Vaccine Effectiveness.

BACKGROUND: Researchers in observational studies of vaccine effectiveness (VE) in which they compared quadrivalent live attenuated vaccine (LAIV4) and inactivated influenza vaccine (IIV) among children and adolescents have shown inconsistent results, and the studies have been limited by small samples. METHODS: We combined data from 5 US studies from 2013-2014 through 2015-2016 to compare the VE of LAIV4 and IIV against medically attended, laboratory-confirmed influenza among patients aged 2 to 17 years by influenza season, subtype, age group, and prior vaccination status. The VE of IIV or LAIV4 was calculated as 100% × (1 - odds ratio), comparing the odds of vaccination among patients who were influenza-positive to patients who were influenza-negative from adjusted logistic regression models. Relative effectiveness was defined as the odds of influenza comparingLAIV4 and IIV recipients. RESULTS: Of 17 173 patients aged 2 to 17 years, 4579 received IIV, 1979 received LAIV4, and 10 615 were unvaccinated. Against influenza A/H1N1pdm09, VE was 67% (95% confidence interval [CI]: 62% to 72%) for IIV and 20% (95% CI: -6% to 39%) for LAIV4. Results were similar when stratified by vaccination in the previous season. LAIV4 recipients had significantly higher odds of influenza A/H1N1pdm09 compared with IIV recipients (odds ratio 2.66; 95% CI: 2.06 to 3.44). LAIV4 and IIV had similar effectiveness against influenza A/H3N2 and B. Our overall findings were consistent when stratified by influenza season and age group. CONCLUSIONS: From this pooled individual patient-level data analysis, we found reduced effectiveness of LAIV4 against influenza A/H1N1pdm09 compared with IIV, which is consistent with published results from the individual studies included.