Surveillance and Vaccine Effectiveness of an Influenza Epidemic Predominated by Vaccine-Mismatched Influenza B/Yamagata-Lineage Viruses in Taiwan, 2011-12 Season

Yi Chun Lo, Jen Hsiang Chuang, Hung Wei Kuo, Wan Ting Huang, Yu Fen Hsu, Ming Tsan Liu, Chang Hsun Chen, Hui Hsun Huang, Chi Hsi Chang, Jih Haw Chou, Feng Yee Chang, Tzou Yien Lin, Wen Ta Chiu

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Abstract

Introduction: The 2011-12 trivalent influenza vaccine contains a strain of influenza B/Victoria-lineage viruses. Despite free provision of influenza vaccine among target populations, an epidemic predominated by influenza B/Yamagata-lineage viruses occurred during the 2011-12 season in Taiwan. We characterized this vaccine-mismatched epidemic and estimated influenza vaccine effectiveness (VE). Methods: Influenza activity was monitored through sentinel viral surveillance, emergency department (ED) and outpatient influenza-like illness (ILI) syndromic surveillance, and case-based surveillance of influenza with complications and deaths. VE against laboratory-confirmed influenza was evaluated through a case-control study on ILI patients enrolled into sentinel viral surveillance. Logistic regression was used to estimate VE adjusted for confounding factors. Results: During July 2011-June 2012, influenza B accounted for 2,382 (72.5%) of 3,285 influenza-positive respiratory specimens. Of 329 influenza B viral isolates with antigen characterization, 287 (87.2%) were B/Yamagata-lineage viruses. Proportions of ED and outpatient visits being ILI-related increased from November 2011 to January 2012. Of 1,704 confirmed cases of influenza with complications, including 154 (9.0%) deaths, influenza B accounted for 1,034 (60.7%) of the confirmed cases and 103 (66.9%) of the deaths. Reporting rates of confirmed influenza with complications and deaths were 73.5 and 6.6 per 1,000,000, respectively, highest among those aged ≥65 years, 50-64 years, 3-6 years, and 0-2 years. Adjusted VE was -31% (95% CI: -80, 4) against all influenza, 54% (95% CI: 3, 78) against influenza A, and -66% (95% CI: -132, -18) against influenza B. Conclusions: This influenza epidemic in Taiwan was predominated by B/Yamagata-lineage viruses unprotected by the 2011-12 trivalent vaccine. The morbidity and mortality of this vaccine-mismatched epidemic warrants careful consideration of introducing a quadrivalent influenza vaccine that includes strains of both B lineages.

Original languageEnglish
Article numbere58222
JournalPLoS One
Volume8
Issue number3
DOIs
Publication statusPublished - Mar 5 2013
Externally publishedYes

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Influenza Vaccines
Taiwan
Viruses
influenza
Human Influenza
Vaccines
vaccines
viruses
monitoring
Sentinel Surveillance
Logistics
death
Antigens
Hospital Emergency Service
Outpatients
Victoria
Health Services Needs and Demand

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

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Surveillance and Vaccine Effectiveness of an Influenza Epidemic Predominated by Vaccine-Mismatched Influenza B/Yamagata-Lineage Viruses in Taiwan, 2011-12 Season. / Lo, Yi Chun; Chuang, Jen Hsiang; Kuo, Hung Wei; Huang, Wan Ting; Hsu, Yu Fen; Liu, Ming Tsan; Chen, Chang Hsun; Huang, Hui Hsun; Chang, Chi Hsi; Chou, Jih Haw; Chang, Feng Yee; Lin, Tzou Yien; Chiu, Wen Ta.

In: PLoS One, Vol. 8, No. 3, e58222, 05.03.2013.

Research output: Contribution to journalArticle

Lo, YC, Chuang, JH, Kuo, HW, Huang, WT, Hsu, YF, Liu, MT, Chen, CH, Huang, HH, Chang, CH, Chou, JH, Chang, FY, Lin, TY & Chiu, WT 2013, 'Surveillance and Vaccine Effectiveness of an Influenza Epidemic Predominated by Vaccine-Mismatched Influenza B/Yamagata-Lineage Viruses in Taiwan, 2011-12 Season', PLoS One, vol. 8, no. 3, e58222. https://doi.org/10.1371/journal.pone.0058222
Lo, Yi Chun ; Chuang, Jen Hsiang ; Kuo, Hung Wei ; Huang, Wan Ting ; Hsu, Yu Fen ; Liu, Ming Tsan ; Chen, Chang Hsun ; Huang, Hui Hsun ; Chang, Chi Hsi ; Chou, Jih Haw ; Chang, Feng Yee ; Lin, Tzou Yien ; Chiu, Wen Ta. / Surveillance and Vaccine Effectiveness of an Influenza Epidemic Predominated by Vaccine-Mismatched Influenza B/Yamagata-Lineage Viruses in Taiwan, 2011-12 Season. In: PLoS One. 2013 ; Vol. 8, No. 3.
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abstract = "Introduction: The 2011-12 trivalent influenza vaccine contains a strain of influenza B/Victoria-lineage viruses. Despite free provision of influenza vaccine among target populations, an epidemic predominated by influenza B/Yamagata-lineage viruses occurred during the 2011-12 season in Taiwan. We characterized this vaccine-mismatched epidemic and estimated influenza vaccine effectiveness (VE). Methods: Influenza activity was monitored through sentinel viral surveillance, emergency department (ED) and outpatient influenza-like illness (ILI) syndromic surveillance, and case-based surveillance of influenza with complications and deaths. VE against laboratory-confirmed influenza was evaluated through a case-control study on ILI patients enrolled into sentinel viral surveillance. Logistic regression was used to estimate VE adjusted for confounding factors. Results: During July 2011-June 2012, influenza B accounted for 2,382 (72.5{\%}) of 3,285 influenza-positive respiratory specimens. Of 329 influenza B viral isolates with antigen characterization, 287 (87.2{\%}) were B/Yamagata-lineage viruses. Proportions of ED and outpatient visits being ILI-related increased from November 2011 to January 2012. Of 1,704 confirmed cases of influenza with complications, including 154 (9.0{\%}) deaths, influenza B accounted for 1,034 (60.7{\%}) of the confirmed cases and 103 (66.9{\%}) of the deaths. Reporting rates of confirmed influenza with complications and deaths were 73.5 and 6.6 per 1,000,000, respectively, highest among those aged ≥65 years, 50-64 years, 3-6 years, and 0-2 years. Adjusted VE was -31{\%} (95{\%} CI: -80, 4) against all influenza, 54{\%} (95{\%} CI: 3, 78) against influenza A, and -66{\%} (95{\%} CI: -132, -18) against influenza B. Conclusions: This influenza epidemic in Taiwan was predominated by B/Yamagata-lineage viruses unprotected by the 2011-12 trivalent vaccine. The morbidity and mortality of this vaccine-mismatched epidemic warrants careful consideration of introducing a quadrivalent influenza vaccine that includes strains of both B lineages.",
author = "Lo, {Yi Chun} and Chuang, {Jen Hsiang} and Kuo, {Hung Wei} and Huang, {Wan Ting} and Hsu, {Yu Fen} and Liu, {Ming Tsan} and Chen, {Chang Hsun} and Huang, {Hui Hsun} and Chang, {Chi Hsi} and Chou, {Jih Haw} and Chang, {Feng Yee} and Lin, {Tzou Yien} and Chiu, {Wen Ta}",
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AU - Lo, Yi Chun

AU - Chuang, Jen Hsiang

AU - Kuo, Hung Wei

AU - Huang, Wan Ting

AU - Hsu, Yu Fen

AU - Liu, Ming Tsan

AU - Chen, Chang Hsun

AU - Huang, Hui Hsun

AU - Chang, Chi Hsi

AU - Chou, Jih Haw

AU - Chang, Feng Yee

AU - Lin, Tzou Yien

AU - Chiu, Wen Ta

PY - 2013/3/5

Y1 - 2013/3/5

N2 - Introduction: The 2011-12 trivalent influenza vaccine contains a strain of influenza B/Victoria-lineage viruses. Despite free provision of influenza vaccine among target populations, an epidemic predominated by influenza B/Yamagata-lineage viruses occurred during the 2011-12 season in Taiwan. We characterized this vaccine-mismatched epidemic and estimated influenza vaccine effectiveness (VE). Methods: Influenza activity was monitored through sentinel viral surveillance, emergency department (ED) and outpatient influenza-like illness (ILI) syndromic surveillance, and case-based surveillance of influenza with complications and deaths. VE against laboratory-confirmed influenza was evaluated through a case-control study on ILI patients enrolled into sentinel viral surveillance. Logistic regression was used to estimate VE adjusted for confounding factors. Results: During July 2011-June 2012, influenza B accounted for 2,382 (72.5%) of 3,285 influenza-positive respiratory specimens. Of 329 influenza B viral isolates with antigen characterization, 287 (87.2%) were B/Yamagata-lineage viruses. Proportions of ED and outpatient visits being ILI-related increased from November 2011 to January 2012. Of 1,704 confirmed cases of influenza with complications, including 154 (9.0%) deaths, influenza B accounted for 1,034 (60.7%) of the confirmed cases and 103 (66.9%) of the deaths. Reporting rates of confirmed influenza with complications and deaths were 73.5 and 6.6 per 1,000,000, respectively, highest among those aged ≥65 years, 50-64 years, 3-6 years, and 0-2 years. Adjusted VE was -31% (95% CI: -80, 4) against all influenza, 54% (95% CI: 3, 78) against influenza A, and -66% (95% CI: -132, -18) against influenza B. Conclusions: This influenza epidemic in Taiwan was predominated by B/Yamagata-lineage viruses unprotected by the 2011-12 trivalent vaccine. The morbidity and mortality of this vaccine-mismatched epidemic warrants careful consideration of introducing a quadrivalent influenza vaccine that includes strains of both B lineages.

AB - Introduction: The 2011-12 trivalent influenza vaccine contains a strain of influenza B/Victoria-lineage viruses. Despite free provision of influenza vaccine among target populations, an epidemic predominated by influenza B/Yamagata-lineage viruses occurred during the 2011-12 season in Taiwan. We characterized this vaccine-mismatched epidemic and estimated influenza vaccine effectiveness (VE). Methods: Influenza activity was monitored through sentinel viral surveillance, emergency department (ED) and outpatient influenza-like illness (ILI) syndromic surveillance, and case-based surveillance of influenza with complications and deaths. VE against laboratory-confirmed influenza was evaluated through a case-control study on ILI patients enrolled into sentinel viral surveillance. Logistic regression was used to estimate VE adjusted for confounding factors. Results: During July 2011-June 2012, influenza B accounted for 2,382 (72.5%) of 3,285 influenza-positive respiratory specimens. Of 329 influenza B viral isolates with antigen characterization, 287 (87.2%) were B/Yamagata-lineage viruses. Proportions of ED and outpatient visits being ILI-related increased from November 2011 to January 2012. Of 1,704 confirmed cases of influenza with complications, including 154 (9.0%) deaths, influenza B accounted for 1,034 (60.7%) of the confirmed cases and 103 (66.9%) of the deaths. Reporting rates of confirmed influenza with complications and deaths were 73.5 and 6.6 per 1,000,000, respectively, highest among those aged ≥65 years, 50-64 years, 3-6 years, and 0-2 years. Adjusted VE was -31% (95% CI: -80, 4) against all influenza, 54% (95% CI: 3, 78) against influenza A, and -66% (95% CI: -132, -18) against influenza B. Conclusions: This influenza epidemic in Taiwan was predominated by B/Yamagata-lineage viruses unprotected by the 2011-12 trivalent vaccine. The morbidity and mortality of this vaccine-mismatched epidemic warrants careful consideration of introducing a quadrivalent influenza vaccine that includes strains of both B lineages.

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