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.Overall (I-squared = 0.0%, p = 0.677)
A(H3N2)
2012_13
Subtotal (I-squared = 0.0%, p = 0.476)
A(H1N1)pdm09
2013_14
Subtotal (I-squared = 0.0%, p = 0.472)
Strain
2014_15
A(H1N1)pdm09
A(H3N2)
A(H3N2)
B/YamagataSubtotal (I-squared = 0.0%, p = 0.653)
A(H1N1)pdm09
B/Yamagata
B/Yamagata
31.93 (23.56, 40.31)
28.00 (-8.00, 50.00)
37.93 (22.26, 53.60)
23.00 (-26.00, 53.00)
25.93 (13.96, 37.90)
effectiveness (95% CI)
38.00 (14.00, 55.00)
30.00 (-37.00, 64.00)
21.00 (5.00, 34.00)
43.00 (17.00, 60.00)37.39 (19.71, 55.08)
45.00 (-32.00, 78.00)
Vaccine
35.00 (8.00, 54.00)
61.00 (-3.00, 86.00)
31.93 (23.56, 40.31)
28.00 (-8.00, 50.00)
37.93 (22.26, 53.60)
23.00 (-26.00, 53.00)
25.93 (13.96, 37.90)
effectiveness (95% CI)
38.00 (14.00, 55.00)
30.00 (-37.00, 64.00)
21.00 (5.00, 34.00)
43.00 (17.00, 60.00)37.39 (19.71, 55.08)
45.00 (-32.00, 78.00)
Vaccine
35.00 (8.00, 54.00)
61.00 (-3.00, 86.00)
0-25-50 0 20 50
Influenza Vaccine Effectiveness
050
100
150
200
250
Adm
issi
ons
(n) w
ith in
fluen
za
2012
-45
2012
-46
2012
-47
2012
-48
2012
-49
2012
-50
2012
-51
2012
-52
2013
-01
2013
-02
2013
-03
2013
-04
2013
-05
2013
-06
2013
-07
2013
-08
2013
-09
2013
-10
2013
-11
2013
-12
2013
-13
2013
-14
2013
-15
2013
-16
2013
-17
2013
-18
2013
-19
2013
-20
2013
-21
2013
-22
2013
-23
2013
-49
2013
-50
2013
-51
2013
-52
2014
-01
2014
-02
2014
-03
2014
-04
2014
-05
2014
-06
2014
-07
2014
-08
2014
-09
2014
-10
2014
-11
2014
-12
2014
-13
2014
-14
2014
-15
2014
-16
2014
-17
2014
-18
2014
-19
2014
-20
2014
-21
2014
-22
2014
-23
2014
-40
2014
-41
2014
-42
2014
-43
2014
-44
2014
-45
2014
-46
2014
-47
2014
-48
2014
-49
2014
-50
2014
-51
2014
-52
2014
-53
2015
-01
2015
-02
2015
-03
2015
-04
2015
-05
2015
-06
2015
-07
2015
-08
2015
-09
2015
-10
2015
-11
2015
-12
2015
-13
2015
-14
2015
-15
2015
-16
2015
-17
2015
-18
2015
-19
2015
-20
2015
-21
Week
A(H1N1)pdm09 (n=1,082) A(H3N2) (n=2,012) A nosubtyped (n=247)B/Yamgata-lin (n=1,168) B/Victoria-lin (n=61) B nosubtyped (n=181)
Global Influenza Surveillance Network, epidemiology and influenza vaccine effec=veness, in three influenza seasons, 2012-‐2015
The study was funded by Sanofi Pasteur
Joan Puig-Barberà1, Anna Sominina2, Elena Burtseva3, Hongjie Yu4, Meral A. Ciblak5, Odile Launay6, Jan Kyncl7, Angels Natividad-Sancho1, Maria Pisareva2, Svetlana Trushakova3, Benjamin J. Cowling8, Selim Badur5, Philippe Vanhems9, Helena Jirincova7, Ainara Mira-Iglesias1, Elizaveta Smorodintseva2, Lyudmila Kolobukhina3, Feng Luzhao4, Kubra Yurctu5, Nezha Lenzi6, Zdenka Mandakova7, for the Global
Influenza Hospital Surveillance Study Group (GIHSN)
1 Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain; 2 Research Institute of Influenza, Saint Petersburg, Russian Federation; 3 D.I. Ivanovsky Institute of Virology FGBC “N.F. Gamaleya FRCEM ”Ministry of Health of Russian Federation, Moscow, Russian Federation; 4 Division of Infectious Disease, Key Laboratory of Surveillance and Early-Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China; 5 National Influenza Reference Laboratory,
Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey; 6 Université Paris Descartes, Sorbonne Paris Cité, Inserm, CIC 1417 and the French Vaccine Research Network (REIVAC), Paris, France.; 7 Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic; 8 School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; 9 Edouard Herriot Hospital, Lyon University Hospital (Hospices Civils de Lyon), Lyon, FranceLenzi6, Zdenka
Mandakova7, for the Global Influenza Hospital Surveillance Study Group (GIHSN)
Abstract : AOIX00541
Influenza vaccine effec=veness in preven=ng admissions with influenza was low to moderate. While influenza vaccina=on is to be recommended for preven=ng influenza related disease, improved vaccines that offer beMer protec=on are needed.
Results
Background
During its first three consecu/ve influenza seasons, 2012/13, 2013/14 and 2014/15 field researchers in par/cipa/ng GIHSN hospitals ac/vely screened consecu/ve admissions possibly related to influenza using a common protocol. Depending on the season, par/cipa/ng hospitals were in Russia, China, the Czech Republic, France, Turkey and Spain.
Fundación para el Fomento de la Inves=gación Biomédica y Sanitaria (FISABIO), Valencia, Spain Phone: +34 961 925 968; e-‐mail: [email protected]
hWp://gihsn.org/
Methods
Keywords: Influenza, Influenza vaccine and Epidemiology
Conclusion
ARer consent, we collected informa/on on socio demographic and clinical characteris/cs and obtained nasal, pharyngeal or nasopharyngeal swabs and ascertained influenza virus subtype or lineage with reverse transcrip/on polymerase chain reac/on (RT-‐PCR). The adjusted odds ra/o (aOR) for admission with influenza related to strain and various pa/ent characteris/cs was es/mated with mul/level mul/variate logis/c regression taking into account calendar /me and country clustering effect. Vaccine effectiveness was estimated as (1-aOR)*100.
We speculate that influenza circula/on variability could be related to evolving immunity in the popula/on and virus adaptability to this ecologic background. Whereas the level of vaccine effec/veness could be related to this background immunity and the driR of the virus that could possibly be related to its gene/c characteris/cs.
Figure 1. Admissions with influenza by season and week. Figure 2. Influenza vaccine effec/veness
41,288 pa/ents were screened, 35,547 were considered eligible, 21,872 met criteria for inclusion and had valid laboratory results. Finally, 4,698 (21%) were influenza posi/ve.
Vaccina/on provided low to moderate protec/on against hospital admission with laboratory –confirmed influenza in adults targeted for influenza vaccina/on. GIHSN can fill a relevant gap in our understanding of influenza, given the opportunity of collabora/on among different teams, the geographic representa/ve surveillance on admissions with influenza and vaccine performance.
Fundación para el Fomento de la Inves4gación Biomédica y Sanitaria (FISABIO), Valencia, Spain Phone: +34 961 925 968; e-‐mail: [email protected] hRp://gihsn.org/
Waning protec-on of influenza vaccina-on. A test-‐nega-ve study in four consecu-ve influenza seasons. Valencia Hospital Network for the Study of Influenza (VAHNSI), Spain.
VAHNSI ac4vity is partly funded by Sanofi Pasteur
Joan Puig-Barberà1,2, Ainara Mira-Iglesias1, Miguel Tortajada-Girbés3, F. Xavier López-Labrador1,4, Ángel Belenguer-Varea5, Mario Carballido-Fernández6, Empar Carbonell-Franco7, Concha Carratalá-Munuera8,9 Ramón Limón-Ramírez10, Joan Mollar-Maseres11, Maria del Carmen Otero-Reigada11, Germán Schwarz-Chavarri12, José Tuells13, Vicente Gil-Guillén9,14, * for the Valencia Hospital Network for the
Study of Influenza and other Respiratory Viruses (VAHNSI)
1. Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Valencia, Spain; 2. Centro de Salud Pública de Castellón, Castellón, Spain; 3. Hospital Doctor Peset, Valencia, Spain; 4. Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; 5. Hospital de La Ribera, Alzira, Spain; 6. Hospital General de Castellón, Spain; 7. Hospital Arnau de Vilanova, Valencia, Spain; 8. Hospital San Juan, Alicante, Spain; 9. Cátedra de Medicina de
Familia. Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan, Alicante, Spain; 10. Hospital de la Plana, Vila-real, Spain; 11. Hospital Universitario y Politécnico La Fe, Valencia, Spain; 12. Hospital General de Alicante, Alicante, Spain; 13. Hospital Universitario del Vinalopó, Elche, Spain; 14. Hospital de Elda, Elda, Spain Disease Control and Prevention, Beijing, China; 6 School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
Abstract : AOIX00065
Annual influenza vaccination is recommended to prevent influenza related complications. There exists an ongoing debate regarding the waning of vaccine protection. We present our results on the relationship of date of vaccination (DOV) with admission with influenza in four consecutive influenza seasons.
We explored if DOV could be explained by age, sex, underlying chronic conditions, previous influenza vaccination, smoking habits, socioeconomic status, previous general practitioner (GP) consultations or hospital admissions. We used a test-negative approach to compare the adjusted odds ratio (aOR) of admissions with influenza and vaccination in the third DOV tertile, with the first DOV tertile as reference, overall, by predominant strain and restricting the analysis only to admissions in 65 years old and older. OR were estimated by a multilevel logistic regression approach adjusted by age, gender, smoking habits, social class, number of chronic conditions, being hospitalized in the last year, GP consultations, days from onset of symptoms to swabbing, calendar time (weeks) in restricted cubic splines and hospital as a random effect. A sensitivity analysis was performed in individuals vaccinated both in the past and current season.
Keywords: Influenza vaccine, waning effect and Epidemiology
Consenting consecutive admissions were included and swabbed. Influenza infection and subtyping was performed by real time reverse transcription polymerase chain reaction (RT-PCR). Only vaccinated patients were included. The study was conducted in four consecutive seasons in the Valencia Region (Figure 1), located in the Eastern Mediterranean coast of Spain, Valencia Region population is 5 million inhabitants. The Valencia network included nine, five, six and ten hospitals in the 2011/12, 2012/13, 2013/14 and 2014/15 seasons, in which we enrolled 1127, 520, 633 and 1599 18 years old and older subjects, belonging to target groups for vaccination, and registered as vaccinated with the seasonal influenza vaccine in Valencia’s Vaccination Information System.
Background
Methods
Figure 1: Par?cipa?ng Health Districts (hospitals) and popula?on.
Conclusion
Waning effect was observed in two mismatched A(H3N2) predominant seasons (11/12 and 14/15). Sparse numbers precluded other analysis by age group, strain or in those vaccinated only in the current season.
Results We ascertained 293, 68, 106 and 357 admissions with influenza in vaccinated patients in 2011/12, 2012/13, 2013/14 and 2014/15 seasons (Figure 2).
Season 2011/12
0
50
100
150
200
250
300
350
2011
-39
2011
-41
2011
-43
2011
-45
2011
-47
2011
-49
2011
-51
2012
-01
2012
-03
2012
-05
2012
-07
2012
-09
2012
-11
2012
-13
2012
-15
Epidemiological week
0
10
20
30
40
50
60
70
Season 2013/14
0
50
100
150
200
250
2013
-39
2013
-41
2013
-43
2013
-45
2013
-47
2013
-49
2013
-51
2014
-01
2014
-03
2014
-05
2014
-07
2014
-09
2014
-11
2014
-13
2014
-15
Epidemiological week
0
2
4
6
8
10
12
14
16
18
20
Season 2012/13
0
20
40
60
80
100
120
140
160
180
200
2012
-39
2012
-41
2012
-43
2012
-45
2012
-47
2012
-49
2012
-51
2013
-01
2013
-03
2013
-05
2013
-07
2013
-09
2013
-11
2013
-13
2013
-15
Epidemiological week
0
2
4
6
8
10
12
Season 2014/15
0
100
200
300
400
500
600
700
2014
-39
2014
-41
2014
-43
2014
-45
2014
-47
2014
-49
2014
-51
2014
-53
2015
-02
2015
-04
2015
-06
2015
-08
2015
-10
2015
-12
2015
-14
Epidemiological week
0
10
20
30
40
50
60
Vaccination week negativesVaccination week positivesB not subtyped B Victoria B Yamagata A not subtyped H3N2 H1N1
Figure 2: Distribu?on of vaccina?on date with RT-‐PCR result and distribu?on of influenza strains by season.
Health department Population Seasons General Castellón 277672 11/12, 12/13, 13/14, 14/15 La Plana 185686 11/12, 12/13, 13/14, 14/15 Arnau de Vilanova 255648 11/12, 14/15 La Fe 192572 11/12, 13/14, 14/15 Doctor Peset 359893 11/12, 12/13, 13/14, 14/15 La Ribera 259125 14/15 San Juan 212894 11/12, 12/13, 13/14, 14/15 Elda 190389 11/12, 12/13, 13/14, 14/15 General Alicante 264490 11/12, 14/15 Vinalopó 153157 14/15 TOTAL 2351526
We observed a higher risk of admission with influenza in those individuals vaccinated at the beginning of the vaccination campaign in the 2011/12 season (aOR=0.68, 95%CI=0.47 to 0.99 of DOV third tertile compared to DOV first tertile) and in the 2014/15 season (aOR=0.68, 95%CI=0.49 to 0.93). Nevertheless, we did not find differences on vaccine protection by DOV tertile in the 2012/13 season (aOR=1.17, 95%CI=0.57 to 2.37) and in the 2013/14 season (aOR=0.94, 95%CI=0.55 to 1.62). Similar estimates were obtained in the sensitivity analysis including only those vaccinated both in the current and previous seasons (Figure 3).
Season 11/12Overall65 years old or olderPredominant strainPredominant strain in 65 years old or olderVaccinated previous and current seasonVaccinated previous and current season in 65 years old or olderSubtotal (I-squared = 0.0%, p = 0.990)
Season 12/13Overall65 years old or olderPredominant strainPredominant strain in 65 years old or olderVaccinated previous and current seasonVaccinated previous and current season in 65 years old or olderSubtotal (I-squared = 0.0%, p = 0.999)
Season 13/14Overall65 years old or olderPredominant strainPredominant strain in 65 years old or olderVaccinated previous and current seasonVaccinated previous and current season in 65 years old or olderSubtotal (I-squared = 0.0%, p = 0.980)
Season 14/15Overall65 years old or olderPredominant strainPredominant strain in 65 years old or olderVaccinated previous and current seasonVaccinated previous and current season in 65 years old or olderSubtotal (I-squared = 0.0%, p = 0.992)
analysisSensitivity
0.68 (0.47, 1.00)0.61 (0.41, 0.91)0.68 (0.46, 1.00)0.60 (0.40, 0.90)0.71 (0.48, 1.05)0.64 (0.42, 0.96)0.65 (0.56, 0.77)
1.17 (0.57, 2.37)1.14 (0.54, 2.44)0.95 (0.38, 2.34)1.18 (0.46, 3.03)1.17 (0.57, 2.40)1.12 (0.52, 2.40)1.13 (0.82, 1.55)
0.94 (0.55, 1.62)0.82 (0.44, 1.54)1.12 (0.59, 2.11)1.19 (0.54, 2.58)0.97 (0.54, 1.72)1.01 (0.53, 1.93)0.99 (0.76, 1.27)
0.68 (0.49, 0.93)0.67 (0.47, 0.94)0.63 (0.45, 0.89)0.61 (0.43, 0.88)0.61 (0.43, 0.86)0.69 (0.49, 0.98)0.65 (0.56, 0.75)
Ratio (95% CI)Adjusted Odds
0.68 (0.47, 1.00)0.61 (0.41, 0.91)0.68 (0.46, 1.00)0.60 (0.40, 0.90)0.71 (0.48, 1.05)0.64 (0.42, 0.96)0.65 (0.56, 0.77)
1.17 (0.57, 2.37)1.14 (0.54, 2.44)0.95 (0.38, 2.34)1.18 (0.46, 3.03)1.17 (0.57, 2.40)1.12 (0.52, 2.40)1.13 (0.82, 1.55)
0.94 (0.55, 1.62)0.82 (0.44, 1.54)1.12 (0.59, 2.11)1.19 (0.54, 2.58)0.97 (0.54, 1.72)1.01 (0.53, 1.93)0.99 (0.76, 1.27)
0.68 (0.49, 0.93)0.67 (0.47, 0.94)0.63 (0.45, 0.89)0.61 (0.43, 0.88)0.61 (0.43, 0.86)0.69 (0.49, 0.98)0.65 (0.56, 0.75)
Ratio (95% CI)Adjusted Odds
1.5 .75 1 2 3
Adjusted odds ratio
Adjusted Odds Ratio <1.00 favours waning of vaccination effect
Figure 3. Adjusted odds ra?o of admission with laboratory confirmed influenza (RT-‐PCR) in pa?ents with later date of vaccina?on (third ter?le) compared to those with and earlier date of vaccina?on (first ter?le).
Num
ber v
acci
nate
d N
umbe
r vac
cina
ted
Num
ber v
acci
nate
d N
umbe
r vac
cina
ted
Num
ber i
nflu
enza
pos
itive
ad
mis
sion
s by
stra
in
Number influenza positive admissions by strain
Num
ber i
nflu
enza
pos
itive
ad
mis
sion
s by
stra
in
Num
ber i
nflu
enza
pos
itive
ad
mis
sion
s by
stra
in
Turkey; 1221; 7%
Valencia; 9318; 56%
Fortaleza; 427; 3%St. Petersburg; 5618;
34%
Admissions with influenza and other respiratory viruses, 2012 to 2015 seasons. Results from the Global Influenza Hospital Surveillance Network (GIHSN).
This network ac/vity is partly funded by Sanofi Pasteur
Joan Puig-Barberà1, Maria Pisareva2, Marilda Siqueira3, Selim Badur4, F. Xavier López-Labrador1,5, Fernanda Edna-Moura6, Ayse Tulay Bagci Bossi7, Ainara Mira-Iglesias1, Veronica Afanasieva2, Sonia Raboni8, Sevim Mese4, Anna Sominina2, for the Global Influenza Hospital Surveillance Study Group (GIHSN)
1 Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain; 2 Research Institute of Influenza, Saint Petersburg, Russian Federation ;3 Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil ;4 National Influenza Reference Laboratory, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey; 5 Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; 6. Universidade Federal de Cearà, Fortaleza, Brazil; 7.
Hacettepe University, Faculty of Medicine, Department of Public Health, Ankara, Turkey; 8. Hospital de Clinicas/Universidade Federal do Paraná, Curitiba, Brazil.
Abstract : AOIX00515
Background
The Global Influenza Hospital Surveillance Network (GIHSN) is a plaCorm able to generate relevant data to understand and define the burden of disease related to influenza and other respiratory viruses (IORV). Admissions with respiratory viral infec/on are however not well described although it is accepted that they generate every year a significant public health problem.
Whereas, 50-‐52% of IORV posi/ves were observed in those under 5 years old, 18-‐27% of IORV posi/ves were among those 65 years old or older. The virus type distribu/on was age-‐dependent.
Fundación para el Fomento de la Inves4gación Biomédica y Sanitaria (FISABIO), Valencia, Spain Phone: +34 961 925 968; e-‐mail: [email protected]
hRp://gihsn.org/
Keywords: Influenza, Influenza vaccine and Epidemiology
Consecu/ve consen/ng admissions with symptoms possibly related to an acute viral respiratory infec/on presen/ng within seven days of symptoms onset were enrolled and swabbed at GIHSN sites. The presence of IORV was assessed by real /me reverse transcrip/on polymerase chain reac/on in Russia (St. Petersburg, three seasons), Turkey (two seasons), Spain (Valencia, three seasons) and Brazil (Fortaleza, one season). Overall, 16,584 admissions were tested for the presence of IORV.
Figure 1: Map of the GIHSN network in the current season (2015/2016).
Methods
Figure 2: Admissions with laboratory result by site.
A(H1N1); 664; 10%
A(H3N2); 1240; 18%
A not subtyped; 155; 2%
B/Yamagata; 664; 10%
B/Victoria; 27; 0%
B not subtyped; 17; 0%RSV; 1400; 21%CoV; 398; 6%
HMPV; 206; 3%
AdV; 262; 4%
BoV; 118; 2%
PIV; 163; 2%
RhV/enterovirus; 921; 13%
mixed infection; 649; 9%
We ascertained 6,884 (41%) IORV posi/ves. Predominant viruses were influenza (40%), RSV (21%) and rhinovirus/enterovirus (13%).
Results
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0 - <5 yrs 5 - <18 yrs 18 - <65 yrs >=65 yrs
Mixed influenza infectionMixed respiratory infectionRhinovirusParainfluenzaBocavirusAdenovirusMetapneumovirusCoronavirusRSVB not subtypedB/VictoriaB/YamagataA not subtypedA(H3N2)A(H1N1)
Figure 4: Virus distribu/on by age groups.
Figure 3: Respiratory viruses distribu/on. Seasons 2012/13 to 2014/15.
Conclusion The results from this mul/center surveillance further confirm the relevance of IORV infec/on worldwide.
Figure 5: Seasonal distribu/on of the probability of admission with IORV in the GIHSN sites in three consecu/ve seasons.
Respiratory syncytial virus (RSV) was dominant in those less than five years old (Figure 4), mostly in 0 to less than 6 months of age (data not shown). In subjects 65 years old and over A(H3N2) was dominant (Figure 4) with 30% or more positives, with its frequency increasing with age (data not shown). In the 65 years old and over, 10% of admissions were positive for RSV, with a decreasing trend by age (Figure 4). There was substantial seasonal variability in the predominance of IORV in included admissions (Figure 5).
T h e G l o b a l I n f l u e n z a H o s p i t a l S u r ve i l l a n c e N e t wo r k a s a g row i n g p l a t fo r m t o g e n e r a t ee p idemio logy ev id ence o n the bu rden o f seve re in f luenza and o the r re sp i ra to r y v i r u sesSophie Druelles1, Clotilde El Guerche-Séblain1,2, Joan Puig-Barberá3, Anna Sominina4, Elena Burtseva5, Jan Kyncl6, Serhat Unal7, Ben Cowling8, Yu Hongjie9, Odile Launay10, Parvaiz Koul11, Guillermo Ruiz-Palacios12, Marilda Siqueira13, Shelly McNeil14, Cédric Mahé1,2, Bruno Lina15 , John Paget16
1Sanofi Pasteur, Global Epidemiology Department, Lyon, France; 2Foundation for Influenza Epidemiology, Lyon, France; 3Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain; 4Research Institute of Influenza of the Ministry of Healthcare of the Russian Federation, WHO National Influenza Centre of Russia, Saint Petersburg, Russia ; 5IvanovskyResearch Institute of Virology, Moscow, Russia ; 6National Institute of Public Health (NIPH), Praha, Czech Republic; 7Turkish Society of Internal Medicine, Ankara, Turkey; 8University of Hong Kong, Hong Kong; 9Chinese Centre for Disease Control and Prevention, Beijing, China; 10i-REIVAC (Innovative Clinical Research Network in Vaccinology), Paris, France; 11Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar,India; 12Mexico National Institutes of Health and High Speciality Hospitals Surveillance Network, Mexico; 13Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil; 14Canadian Center for Vaccinology, Halifax, Canada; 15Centre National de Référence de la Grippe, HCL & UCBL, Lyon, France; 16Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
Results of each season and pooled analyses are presented at the GIHSN Global Annual Meeting each year in the presence of influenza expertsand representatives from international institutions involved in epidemiology surveillance.
Results are regularly published in scientific journals and available on www.gihsn.org.
The GIHSN studies were conducted in 4, then 5 and finally 6 countries during the 2012-2013, 2013-2014 and 2014-2015 influenza seasons. The network currently includes more than 40 hospitals in 10 countries and the number of samples has increased by 62% from 2012 to 2015.
RESULTS
Option IX for the control of influenza - 24-28 August 2016, Chicago, USACorresponding author: Sophie Druelles, [email protected]
The GIHSN is an international public-private partnership initiated by Sanofi Pasteur. It is
coordinated by a regional public health foundation, FISABIO (Spain), and composed of several
country partners affiliated with National Health Authorities.
This is a multi-centre, prospective, active surveillance, hospital-based epidemiological study. A
standard protocol is shared between sites allowing comparison and pooling of results between sites.
When vaccine coverage is sufficient, vaccine effectiveness is assessed using a test negative design.
The sustainability of the GIHSN has recently been reinforced by the creation of the Foundation for
Influenza Epidemiology in September 2015, governed by an Executive Committee that meets once
a year to evaluate new proposals that are eligible for funding.
Notwithstanding the funding mechanisms of the Foundation, each study site retains full ownership
of the data.
The GIHSN and the Foundation for Influenza Epidemiology: development of a collaborativeframework● All studies are funded through grants from the Foundation for Influenza Epidemiology
● Coordination activities and technical support is provided by FISABIO, an independent health
institute based in Spain
● GIHSN sites funded by the Foundation are invited to share data generated during the season
with FISABIO to produce the pooled analysis presented at the annual meeting
● This platform is an opportunity to plug additional research components such as other respiratory
viruses
Every year, the Foundation for Influenza Epidemiology supports projects aligned with the GIHSN
mission. Non-profit organizations that could coordinate a pool of hospitals in joining the GIHSN are
eligible to respond to a call for proposal for funding, launched in May.
METHODSBackground: Very few hospital-based surveillance systems offer
standardized common core protocols over a broad geographical area
and there is a need to produce reliable influenza burden estimates.
To fill this gap, the Global Influenza Hospital Surveillance Network
(GIHSN) was initiated in 2011 and is now expanding.
Methods: The GIHSN is an international public-private partnership
initiated by Sanofi Pasteur. It is coordinated by a regional public
health foundation, FISABIO (Spain), and composed of several
country partners affiliated with National Health Authorities. Results of
each season and pooled analyses are presented at the GIHSN
Global Annual Meeting each year in the presence of influenza experts
and representatives from international institutions involved in
epidemiology surveillance.
The sustainability of the network has recently been reinforced by the
creation of the Foundation for Influenza Epidemiology in September
2015, governed by an Executive Committee that meets once a year
to evaluate new proposals that are eligible for funding. The
Foundation is an opportunity to facilitate additional funding from
external donors (private and public) and it supports not-for-profit
organizations able to coordinate a pool of hospitals with
epidemiological research projects aligned with the GIHSN mission.
As well as supporting the GIHSN influenza studies, it represents a
new and growing platform to develop research on the epidemiology
of other respiratory viruses. Notwithstanding the funding mechanisms
of the Foundation, each study site retains full ownership of the data.
Results: The GIHSN studies were conducted in 4, then 5 and finally
6 countries during the 2012-2013, 2013-2014 and 2014-2015
influenza seasons. The network currently includes more than 40
hospitals in 10 countries and the number of samples tested has
increased by 62% from 2012 to 2015. Results are regularly published
in scientific journals and available on www.gihsn.org.
Conclusions: The enlargement of the GIHSN network is an
opportunity to learn from the variations of epidemiological patterns and
burden of respiratory viruses across regions and to collect more
representative data over time. An increase in the number of GIHSN
partners will enable an increased sample size, thus amplifying the
sensitivity and external validity of the results. Currently there is a need
to expand the GIHSN network to additional Southern Hemisphere
countries, to enable more specific and sensitive comparisons across
sites and seasons.
ABSTRACT
Very few hospital-based surveillance systems offer standardized
common core protocols over a broad geographical area and there is
a need to produce reliable influenza burden estimates. To fill this gap,
the Global Influenza Hospital Surveillance Network (GIHSN) was
initiated in 2011 and is now expanding.
BACKGROUND The enlargement of the GIHSN network is an opportunity to learn from the variations of epidemiological patterns and burden of respiratoryviruses across regions and to collect more representative data over time. An increase in the number of GIHSN partners will enable anincreased sample size, thus amplifying the sensitivity and external validity of the results. Currently there is a need to expand the GIHSNnetwork to additional Southern Hemisphere countries, to enable more specific and sensitive comparisons across sites and seasons.
C O N C L U S I O N S
Quantify thedistribution of thedifferent influenza
viruses among severecases
Evaluate theburden of severeinfluenza disease
Measure theeffectiveness of influenza seasonalvaccines
HOSPITALSURVEILLANCE
NETWORK
The three main scientific objectives of the network
Further informationMore information about the network and description of the implementing partners can be found on the Global Influenza Hospital Surveillance Network website: www.gihsn.org
FOUNDATION FOR INFLUENZAEPIDEMIOLOGY
Governance: Executive Committee9 members (scientific representatives, influenza
experts, representative of external donors)
Support for not-for-profit organizations or institutions able tocoordinate a pool ofhospitals, and with
epidemiologicalresearch projectsaligned with the
GIHSN
New and growingplatform to develop
research onepidemiology of
influenza and otherrespiratory viruses
Opportunity tofacilitate additional
funding from privateand public donors
Main features of the Foundation for Influenza Epidemiology
Role of the institution in the national/regionalinfluenza surveillance
system
Geographicalrepresentativeness
of the site for the GIHSN mission
Scientific relevance ofthe proposal and
the proposed design
On-site laboratorycapacities to testinfluenza strains
by RT-PCR
Experience in conductingepidemiological studies,
in particular similar activesurveillance study
Level of co-fundingfrom the applicant
CRITERIA FORSELECTION OFPROPOSALS
Criteria for the selection of proposals
TurkeyTurkish Society of Internal Medicine
Abc Coordination partnersAbc Implementing partners GIHSN Coordinating Centre
Czech RepublicNational Institute of
Public Health
Ivanovsky Research Institute of virology& Research Institute of Influenza,
WHO NICCanada
Canadian Centrefor Vaccinology
MexicoMexico National Institutes
of Health and HighSpeciality Hospitals
Surveillance Network
Oswaldo Cruz Foundation(FIOCRUZ)
Fondation Mérieux
IndiaSher-i-Kashmir of
Medical Sciences (SKIMS)
ChinaChinese Centre for Disease Control
and PreventionUniversity of Hong Kong
Francei-REIVAC & Fluvac
Sanofi Pasteur
Russia
Brazil
SpainFISABIO
Current partners and implementing sites for the 2015-2016 influenza season
Season Number of Number of Number of Number of Number of countries implementing people included positive influenza positives for other
hospitals for ILI cases respiratory viruses2012-2013 4 21 5,906 1,545 (30.7%) 478 (8.1%)2013-2014 5 24 5,963 1,139 (19.2%) 884 (15.3%)2014-2015 6 27 9,589 2,176 (22.7%) 2,475 (22.2%)
Evolution of the Global Influenza Hospital Network over the seasons