Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 18, Number 5—May 2012
Research

No Association between 2008–09 Influenza Vaccine and Influenza A(H1N1)pdm09 Virus Infection, Manitoba, Canada, 2009

Salaheddin M. MahmudComments to Author , Paul Van Caeseele, Gregory Hammond, Carol Kurbis, Tim Hilderman, and Lawrence Elliott
Author affiliations: University of Manitoba, Winnipeg, Manitoba, Canada (S.M. Mahmud, P. Van Caeseele, G. Hammond, T. Hilderman, L. Elliott); Winnipeg Regional Health Authority, Winnipeg (S.M. Mahmud, C. Kurbis); Cadham Provincial Laboratory, Winnipeg (P.V. Caeseele); Manitoba Health, Winnipeg (T. Hilderman, L. Elliott)

Main Article

Table 1

Definitions of variables used in analyses to determine possible association between receipt of 2008–09 TIV and subsequent infection with influenza A(H1N1)pdm09 virus, Manitoba, Canada, 2009*†

Variable Definition
Drugs‡
For HIV Protease inhibitors (J05AE*), nucleoside and nucleotide reverse transcriptase inhibitors (J05AF*), nonnucleoside reverse transcriptase inhibitors (J05AG*), antivirals for treatment of HIV infections, combinations (J05AR*)
For influenza Neuraminidase inhibitors (J05AH*) or cyclic amines (J05AC*)
For diabetes Drugs used in diabetes (A10*), insulins and analogs (A10A*), blood glucose lowering drugs, excluding insulins (A10B*)
Immunosuppressants Antineoplastic agents (L01*), immunosuppressants (L04A*)
Systemic antimicrobials Antibacterials for systemic use (J01*), antimycotics for systemic use (J02*), antimycobacterials (J04*)
Systemic steroids Corticosteroids for systemic use, plain (H02A*), glucocorticoids (H02AB*), corticosteroids for systemic use, combinations (H02B*)
Pregnancy§
Ongoing pregnancy >1 admission code (O10–16, O20–29, O30–48, O94–99, Z32–36) or >2physician claims (640–649, V22) or >1 tariff code for prenatal services; must be within ±30 d of the index date (26)
Completion of pregnancy >1 admission code (O8, O65–75, O80–84, O85–92, Z37–39) or >2 physician claims (650–659, 670–676) or >1 tariff code for delivery, abortion or postnatal services; must be within 270 d following the index date (26)
Medical condition§¶
Alcoholism >1 admission (E24.4, E51.2, E52, F10, G31.2, G62.1, G72.1, I42.6, K29.2, K70, K86.0, O35.4, P04.3, Q86.0, R78.0, T50.6, T51.0, T51.1, T51.9, X45, X65, Y15, Y57.3, Y90, Y91, Z50.2, Z71.4, Z72.1, Z81.1) or >2 physician claims (291, 303)
Anemia >1 admission (D50–64) or >2 physician claims (280–285)
Asthma >1 admission (J45, J46) or >2 physician claims (493)
Cancer, excluding NMS >1 admission (C00–43, C45–97) or >1 physician claim (140–172, 174–209, 235–239)
Cardiovascular disease >1 admission (I00–99, O11) or >2 physician claims (390–519)
Chronic renal failure >1 admission (I12.0, I13.1, N18, N19, N25.0, Z49, Z99.2) or >2 physician claims (403–404, 586–587)
Chronic respiratory condition >1 admission (J40–99, O24) or >2 physician claims (490–496, 500–508)
COPD >1 admission (J40–44, O24) or >2 physician claims (630–633, 634–639, 490–492, 496)
Diabetes >1 admission (E10–14, G590, G632, H280, H360, M142, M146, N083, O24) or >2 physician claims (250) or >2 prescriptions for drugs used in treatment of diabetes
HIV/AIDS >1 admission (B20–24, R75, Z21) or >2 physician claims (042 V08) or >1 prescriptions for drugs used in treatment of HIV
Hypertension >1 admission (I10–15, I67.4, O11) >2 physician claims (401–405)
Immunodeficiency >1 admission (D80–D84, D89) or >2 physician claims (288, 279)
Immunosuppressed Having an organ transplant or a diagnosis of HIV/AIDS, other immunodeficiency disorders or cancer (other than nonmelanoma skin cancer), or receiving prescriptions for immunosuppressants or systemic steroids
Ischemic heart disease >1 admission (I20–25) or >1 physician claims (410–414)
Organ transplant >1 admission (T86, Y83.0, Z94) or >2 physician claims (V42)
Stroke >1 admission (I61, I63, I64, I67.9, I69) or >2 physician claims (431, 434, 436–438)
Substance abuse >1 admission (F11–16, F18–19) or >2 physician claims (292, 304,305)
Other
Area of residence Based on postal code of current address and the North-South relationship variable derived by using PCCF+#; North includes areas coded as “North” or "North transition"; South includes areas coded as "South" or "South transition"

*Asterisks indicate a wild-card character used as an alternative to listing all disease or drug codes within a section or subsection of the corresponding classification system.
†TIV, inactivated trivalent influenza vaccine; NMS, nonmelanoma skin cancer; COPD, chronic obstructive pulmonary disease.
‡Drugs were classified based according to their drug identification number and the Anatomical Therapeutic Chemical Classification System with Defined Daily Doses (www.who.int/classifications/atcddd/en/).
§Codes in parentheses are International Classification of Diseases (ICD)-10-CA codes for hospital admission data and ICD-9-CM codes for physician claims data.
¶Based on previously validated chronic disease identification algorithms with modifications.
#Automated Postal Code Conversion File Plus system, Statistics Canada (www.statcan.gc.ca/bsolc/olc-cel/olc-cel?lang=eng&catno=82F0086X).

Main Article

References
  1. Skowronski  DM, De Serres  G, Crowcroft  NS, Janjua  NZ, Boulianne  N, Hottes  TS, Association between the 2008–09 seasonal influenza vaccine and pandemic H1N1 illness during spring–summer 2009: four observational studies from Canada. PLoS Med. 2010;7:e1000258. DOIPubMedGoogle Scholar
  2. Garcia-Garcia  L, Valdespino-Gomez  JL, Lazcano-Ponce  E, Jimenez-Corona  A, Higuera-Iglesias  A, Cruz-Hervert  P, Partial protection of seasonal trivalent inactivated vaccine against novel pandemic influenza A/H1N1 2009: case–control study in Mexico City. BMJ. 2009;339:b3928. DOIPubMedGoogle Scholar
  3. Echevarría-Zuno  S, Mejía-Aranguré  JM, Mar-Obeso  AJ, Grajales-Muñiz  C, Robles-Pérez  E, González-León  M, Infection and death from influenza A H1N1 virus in Mexico: a retrospective analysis. Lancet. 2009;374:2072–9. DOIPubMedGoogle Scholar
  4. Carcione  D, Giele  C, Goggin  LS, Kwan  KS, Smith  DW, Dowse  GK, Association between 2009 seasonal influenza vaccine and influenza-like illness during the 2009 pandemic: preliminary results of a large household transmission study in Western Australia. Euro Surveill. 2010;15:pii:19616.PubMedGoogle Scholar
  5. Kelly  HA, Grant  KA, Fielding  JE, Carville  KS, Looker  CO, Tran  T, Pandemic influenza H1N1 2009 infection in Victoria, Australia: no evidence for harm or benefit following receipt of seasonal influenza vaccine in 2009. Vaccine. 2011;29:6419–26. DOIPubMedGoogle Scholar
  6. Pebody  R, Andrews  N, Waight  P, Malkani  R, McCartney  C, Ellis  J, No effect of 2008/09 seasonal influenza vaccination on the risk of pandemic H1N1 2009 influenza infection in England. Vaccine. 2011;29:2613–8. DOIPubMedGoogle Scholar
  7. Puig-Barberà  J, Arnedo-Pena  A, Pardo-Serrano  F, Tirado-Balaguer  MD, Pérez-Vilar  S, Silvestre-Silvestre  E, Effectiveness of seasonal 2008–2009, 2009–2010 and pandemic vaccines, to prevent influenza hospitalizations during the autumn 2009 influenza pandemic wave in Castellón, Spain. A test-negative, hospital-based, case–control study. Vaccine. 2010;28:7460–7. DOIPubMedGoogle Scholar
  8. Larrauri  A, Savulescu  C, Jiménez-Jorge  S, Pérez-Breña  P, Pozo  F, Casas  I, Influenza pandemic (H1N1) 2009 activity during summer 2009: effectiveness of the 2008–9 trivalent vaccine against pandemic influenza in Spain. Gac Sanit. 2011;25:23–8. DOIPubMedGoogle Scholar
  9. Iuliano  AD, Reed  C, Guh  A, Desai  M, Dee  D, Kutty  P, Notes from the field: outbreak of 2009 pandemic influenza A (H1N1) virus at a large public university in Delaware, April–May 2009. Clin Infect Dis. 2009;49:1811–20. DOIPubMedGoogle Scholar
  10. Centers for Disease Control and Prevention. Effectiveness of 2008–09 trivalent influenza vaccine against 2009 pandemic influenza A (H1N1)—United States, May–June 2009. MMWR Morb Mortal Wkly Rep. 2009;58:1241–5.PubMedGoogle Scholar
  11. Lessler  J, Reich  NG, Cummings  DAT. Outbreak of 2009 pandemic influenza A (H1N1) at a New York City school. N Engl J Med. 2009;361:2628–36. DOIPubMedGoogle Scholar
  12. Hancock  K, Veguilla  V, Lu  X, Zhong  W, Butler  EN, Sun  H, Cross-reactive antibody responses to the 2009 pandemic H1N1 influenza virus. N Engl J Med. 2009;361:1945–52. DOIPubMedGoogle Scholar
  13. Lee  VJ, Tay  JK, Chen  MIC, Phoon  M, Xie  M, Wu  Y, Inactivated trivalent seasonal influenza vaccine induces limited cross-reactive neutralizing antibody responses against 2009 pandemic and 1934 PR8 H1N1 strains. Vaccine. 2010;28:6852–7. DOIPubMedGoogle Scholar
  14. Pascua  PNQ, Song  MS, Lee  JH, Park  KJ, Kwon  H, Baek  YH, Evaluation of the efficacy and cross-protectivity of recent human and swine vaccines against the pandemic (H1N1) 2009 virus infection. PLoS ONE. 2009;4:e8431. DOIPubMedGoogle Scholar
  15. Loeb  M, Earn  DJ, Smieja  M, Webby  R. Pandemic (H1N1) 2009 risk for nurses after trivalent vaccination. Emerg Infect Dis. 2010;16:719–20.PubMedGoogle Scholar
  16. Chen  MIC, Lee  VJM, Lim  WY, Barr  IG, Lin  RTP, Koh  GCH, 2009 Influenza A (H1N1) seroconversion rates and risk factors among distinct adult cohorts in Singapore. JAMA. 2010;303:1383–91. DOIPubMedGoogle Scholar
  17. Kelly  H, Barry  S, Laurie  K, Mercer  G. Seasonal influenza vaccination and the risk of infection with pandemic influenza: a possible illustration of non-specific temporary immunity following infection. Euro Surveill. 2010;15:pii:19722.PubMedGoogle Scholar
  18. Glezen  WP. How did the 2008–2009 seasonal influenza vaccine affect the pandemic? Clin Infect Dis. 2010;51:1380–2. DOIPubMedGoogle Scholar
  19. Embree  J. Pandemic 2009 (A)H1N1 influenza (swine flu)—the Manitoba experience. Biochem Cell Biol. 2010;88:589–93. DOIPubMedGoogle Scholar
  20. Campbell  A, Rodin  R, Kropp  R, Mao  Y, Hong  Z, Vachon  J, Risk of severe outcomes among patients admitted to hospital with pandemic (H1N1) influenza. CMAJ. 2010;182:349–55. DOIPubMedGoogle Scholar
  21. National Advisory Committee on Immunization (NACI). Statement on influenza vaccination for the 2008–2009 season. An Advisory Committee Statement (ACS) [in French]. Can Commun Dis Rep. 2008;34(ACS-3):1–46. PMID 18802991
  22. LeBlanc  JJ, Li  Y, Bastien  N, Forward  KR, Davidson  RJ, Hatchette  TF. Switching gears for an influenza pandemic: validation of a duplex reverse transcriptase PCR assay for simultaneous detection and confirmatory identification of pandemic (H1N1) 2009 influenza virus. J Clin Microbiol. 2009;47:3805–13. DOIPubMedGoogle Scholar
  23. Roberts  JD, Poffenroth  LA, Roos  LL, Bebchuk  JD, Carter  AO. Monitoring childhood immunizations: a Canadian approach. Am J Public Health. 1994;84:1666–8. DOIPubMedGoogle Scholar
  24. Martens  PJ, Frohlich  N, Carriere  KC, Derksen  S, Brownell  M. Embedding child health within a framework of regional health: population health status and sociodemographic indicators. Can J Public Health. 2002;93(Suppl 2):S15–20.PubMedGoogle Scholar
  25. Lix  L, Yogendran  M, Burchill  C, Metge  C, McKeen  N, Moore  D, Defining and validating chronic diseases: an administrative data approach. Winnipeg (Manitoba, Canada): Manitoba Centre for Health Policy; 2006.
  26. Hardy  JR, Holford  TR, Hall  GC, Bracken  MB. Strategies for identifying pregnancies in the automated medical records of the General Practice Research Database. Pharmacoepidemiol Drug Saf. 2004;13:749–59. DOIPubMedGoogle Scholar
  27. Zarychanski  R, Stuart  TL, Kumar  A, Doucette  S, Elliott  L, Kettner  J, Correlates of severe disease in patients with 2009 pandemic influenza (H1N1) virus infection. CMAJ. 2010;182:257–64. DOIPubMedGoogle Scholar
  28. Dupont  WD. Power calculations for matched case–control studies. Biometrics. 1988;44:1157–68. DOIPubMedGoogle Scholar
  29. Garten  RJ, Davis  CT, Russell  CA, Shu  B, Lindstrom  S, Balish  A, Antigenic and genetic characteristics of swine-origin 2009 A (H1N1) influenza viruses circulating in humans. Science. 2009;325:197–201. DOIPubMedGoogle Scholar
  30. Cowling  BJ, Ng  S, Ma  ESK, Cheng  CKY, Wai  W, Fang  VJ, Protective efficacy of seasonal influenza vaccination against seasonal and pandemic influenza virus infection during 2009 in Hong Kong. Clin Infect Dis. 2010;51:1370–9. DOIPubMedGoogle Scholar
  31. Janjua  NZ, Skowronski  DM, Hottes  TS, De Serres  G, Crowcroft  NS, Rosella  LC. Seasonal vaccine and H1N1. Selection bias explains seasonal vaccine’s protection. BMJ. 2009;339:b4972. DOIPubMedGoogle Scholar
  32. Janjua  NZ, Skowronski  DM, Hottes  TS, De Serres  G, Crowcroft  NS, Rosella  LC. Seasonal vaccine effectiveness against pandemic A/H1N1 [letter]. Lancet. 2010;375:801–2. DOIPubMedGoogle Scholar
  33. Echevarría-Zuno  S, Mejía-Aranguré  JM, Grajales-Muñiz  C, Gonzalez-Bonilla  C, Borja-Aburto  VH. Seasonal vaccine effectiveness against pandemic A/H1N1 [letter]. Lancet. 2010;375:author reply 802–3. DOIPubMedGoogle Scholar
  34. Johns  MC, Eick  AA, Blazes  DL, Lee  S, Perdue  CL, Lipnick  R, Seasonal influenza vaccine and protection against pandemic (H1N1) 2009–associated illness among US military personnel. PLoS ONE. 2010;5:e10722. DOIPubMedGoogle Scholar
  35. Crum-Cianflone  NF, Blair  PJ, Faix  D, Arnold  J, Echols  S, Sherman  SS, Clinical and epidemiologic characteristics of an outbreak of novel H1N1 (swine origin) influenza A virus among United States military beneficiaries. Clin Infect Dis. 2009;49:1801–10. DOIPubMedGoogle Scholar
  36. Savitz  DA. Interpreting epidemiologic evidence: strategies for study design and analysis. Oxford (New York): Oxford University Press; 2003.
  37. Wacholder  S, McLaughlin  JK, Silverman  DT, Mandel  JS. Selection of controls in case–control studies: I. principles. Am J Epidemiol. 1992;135:1019–28.PubMedGoogle Scholar
  38. Statistics Canada. Table 105-0501. Health indicator profile, annual estimates, by age group and sex, Canada, provinces, territories, health regions (2007 boundaries) and peer groups, occasional, CANSIM (database). 2011 [cited 2011 Apr 17]. http://www5.statcan.gc.ca/cansim/a26?lang=eng&retrLang=eng&id=1050501&paSer=&pattern=&stByVal=1&p1=1&p2=-1&tabMode=dataTable&csid=
  39. Robinson  JR, Young  TK, Roos  LL, Gelskey  DE. Estimating the burden of disease: comparing administrative data and self-reports. Med Care. 1997;35:932–47. DOIPubMedGoogle Scholar
  40. Shrank  WH, Patrick  AR, Brookhart  MA. Healthy user and related biases in observational studies of preventive interventions: a primer for physicians. J Gen Intern Med. 2011;26:546–50. DOIPubMedGoogle Scholar

Main Article

Page created: April 05, 2012
Page updated: April 05, 2012
Page reviewed: April 05, 2012
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external