I-MOVE network Monitoring Influenza Vaccine Effectiveness in Europe

I-MOVE network Monitoring Influenza Vaccine Effectiveness in Europe I-MOVE network Esther Kissling Alain Moren Marta Valenciano 1 1

I-MOVE objectives (Influenza monitoring VE in Europe) ECDC tender 2007 To identify and pilot test methods to measure seasonal and pandemic influenza VE in EU and EEA To develop a system to monitor on a routine and real-timebasis IVE in EU and EEA have early estimates during the influenza season have a system ready to assess and monitor IVE in a pandemic 2 2

2007-8, Planning phase Establishing a network of partners Identification of methods to measure influenza VE in EU /EEA - Literature review - Influenza VE survey among EU member states - MS & expert workshop on influenza VE studies Main recommendations - Various study designs - Based on existing sentinel networks & existing DB - Variables to control for positive and negative confounding - Laboratory confirmed outcome Influenza VE generic study protocols 3

I-MOVE network2008/9 2011/12 Partners 26 institutes 17 MS EU / EEA MS Studies in 15 sites nationalcase-control based on sentinel networks multicentrecase-control cohorts based on primary care computerised registers with nested case control screening Case-control Cohort with nested case-control Screening 4 4

I-MOVE cohort studies with nested case control (ref presentations Nick Andrews and Jesús Castilla) 5 5

I-MOVE cohort studies Methods Large electronic GP databases England 1,005,132 ; Scotland 93,380; Navarra 604,595 All ages Outcomes ILI all respiratory illness hospitalisations death laboratory confirmed (nested case-control) Adjustment for + and - confounding Analysis Poisson/Time dependent, Cox regression Logistic regression (case-control) 6 6

I-MOVE cohorts: Preliminary IVE (end of March 2011) against MA-ILI 100 80 VE % 60 40 20 21 35 52 38 64 27 0 Crude Adjusted Crude Adjusted Crude Adjusted England (873,289) - Poisson regression Scotland (93,380) - Cox Navarra (604,595) - Cox 7 Country /region (population size) - Statistical method 7

I-MOVE case-control studies 8 8

Methods: Multicentre case-control study Sentinel networks(> 1000 GPs) interview and swabof ILI patients Reference laboratories cases: ILI positive for influenza controls: ILI negative(test-negative) SentinelGPs: sample of ILI patients Reflab: PCR, culture Vaccination status vaccinated: vaccine> 14 daysbeforeili onset Covariates to adjust for + and - confounding Pooled analysis ref E Kissling presentation Cases: ILI PCR + Controls: ILI PCR - 9 9

Multicentre case-control Strengthening methods along the seasons Study sites, population, sample size Pilot season 5 study sites, elderly (N= 327) 2011/12 8 study sites, all population(n=4747) EU ILI case definition Pilot season 4/5 2011/12 7/8 Selection of ILI patients to swab All elderly swabbed 2011/12 systematic selection of patients to swab in other age groups(8/8) 10 10

100 Influenza VE by age and risk groups, type/subtype Multicentre case control study, I-MOVE, 2007-12, EU Adjusted vaccine effectiveness (%) 80 60 40 20 59 65 60 72 78 73 52 66 47 56 51 60 56 25 63 15 0 N=292 196 65-74 N=96 75+ 2902 2688 <65 1463 15-64 4410 1422 0-14 2656 15-64 291 65+ 2506 2119 A(H1N1) B Overall Age group Overall Age Group Overall Age group Type/Subtype Target group Seasonal vaccine 2008/9 (study population: > 64 years) Pandemic vaccine 2009/10 (imputed data) Seasonal vaccine 2010/11 (imputed data) 1004 1014 431 15-64 Overall Age Group 503 65+ Age Group Seasonal vaccine 2011/12 (target group only; VE against AH3) 11

Screening method Italy, Portugal, Spain, England, Scotland 12 12

Screening method: pandemic IVE against lab. confirmed influenza by age group 2009-10 season, Spain Courtesy Amparo Larrauri 100 93 91 80 81 VE % 60 51 40 20 0 0-4 y 5-14 y 15-64 y > 64 y 13 13

MA-ILI 2010-11, preliminary Screening IVE (end of March) Effectiveness by week, England 100 Courtesy Dougas Fleming 80 60 VE % 40 47 43 41 40 40 40 39 39 38 38 20 0 03- Jan 10- Jan 17- Jan 24- Jan 31- Jan 07- Feb 14- Feb 21- Feb 28- Feb 07- Mar 14 14

The I-MOVE network Highly motivated study teams Continuous exchanges between I-MOVE members and with external experts during the season teleconferences, workshops annual meeting website https://sites.google.com/site/epiflu/home 15 15

The I-MOVE network Communication 29 articles published Scientific conferences(national and international) I-MOVE results included in meta-analysis Since 2009/10 preliminary results communicated to EMA, WHO, ECDC Funding 2008/9-2011/12: funded by study sites and ECDC 2012/13: funded by study sites and EpiConcept 16 16

Conclusions A consolidated network for measuring IVE estimates from several countries, designs laboratory confirmed outcome control for positive / negative confounders Early estimates in seasons or pandemics IVE by age group, subtype, target population Contribution to strengthen influenza surveillance case definition systematic sampling Challenge Long term funding. 17 17

Patients Influenza Sentinel networks Study sites I-MOVE - Denmark: A Mazick, K Molbak(2008-9) - England, Wales RCGP: D Fleming, H Durnall - France OpenRome/ GROG: JM Cohen, A Mosnier, I Daviaud - Hungary, NCE, : B Oroszi, K Horvath - Ireland, HSE: AS Barret, J Rebolledo, J O'Donnell - Italy, ISS: C Rizzo, A Bella, MC Rota, S Erlich - Poland National Institute of Public Health: I Paradowska-Stankeiwicz, M Fluchowska, P Stefanoff - Portugal, Inst NacSaudeDr Ricardo Jorge: B Nunes, A Machado, J MarinhoFalcão, R Guiomar - Romania, CantacuzinoInstitut: V Alexandrescu, D Pitigoiti, E Lupulescu, - Scotland, HPS: J McMenamin, C Robertson - Spain, CNE, ISCIII: A Larrauri, S Jiménez, S De Mateo - Spain, Navarra Public Health Institute: J Castilla, I Martínez - UK, HPA: R Pebody, N Andrews, P Hardelid, G Kaftatos ECDC: B Ciancio, P Kramarz, A Nicoll EpiConcept: E Kissling, A Moren, M Valenciano C Savulescu, T Seyler, A Halm, V Nancey, N Colombo, G Jeannerod Other partners Institutes - Belgium IPH - Spain Valencia CSISP - Finland. THL - France, InVS - France, Sentinel - Greece, KEEPNO - Italy, Campobasso, Catholic University - Norway, FHI - The Netherlands, RIVM - The Netherlands, Erasmus University - Sweden, SMI Thanks 18 18