Estimating Influenza Vaccine Effectiveness in the DoD
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Estimating Influenza Vaccine Effectiveness in the DoD. Col James Neville, MD, MPH Deputy Director 210-536-2002. Sustaining Readiness through Healthy Communities. Existing surveillance programs (overview) Data available for evaluation of VE Navy VE estimate (recruit centers)

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Estimating Influenza Vaccine Effectiveness in the DoD

Col James Neville, MD, MPH

Deputy Director

210-536-2002

Sustaining Readiness through Healthy Communities


Topics to be covered

Existing surveillance programs (overview)

Data available for evaluation of VE

Navy VE estimate (recruit centers)

Army VE estimate (Ft. Lee outbreak)

AF VE estimate (phone survey, underway)

Topics to be Covered


Existing surveillance programs af

2000-2001 Collaborating Sites

Existing Surveillance Programs-AF

  • AF Program (AFIOH)

  • 27 sentinel sites

  • Clinical and convenience sampling

  • 1O objective: isolates


Existing surveillance programs navy

Great Lakes

Cape

May

Ft Leonard Wood

Ft Bragg

Ft Jackson

MCRDSan Diego

MCRD Parris Island

Lackland AFB

Existing Surveillance Programs-Navy

  • AF Program (AFIOH)

  • 27 sentinel sites

  • Clinical and convenience sampling

  • 1O objective : isolates

  • Navy Program (NHRC)

  • Military Training Centers

  • Convenience sampling

  • Objective: ILI rates, isolates


Existing surveillance programs army
Existing Surveillance Programs-Army

  • AF Program (AFIOH)

  • 27 sentinel sites

  • Clinical and convenience sampling

  • 1O objective: isolates

  • Navy Program (NHRC)

  • Military Training Centers

  • Convenience sampling

  • Objective: ILI rates, isolates

  • Army Program

  • MEDCENs, clinical virology labs

  • Special studies

- Army MEDCEN



Ili activity data sources1
ILI Activity Data Sources

  • Local public health officer reports


Data sources cont d
Data Sources (cont’d)

  • Local public health officer reports

  • Coded ambulatory visits

    • ESSENCE

    • “DNBI”


Data sources cont d1
Data Sources (cont’d)

  • Local public health officer reports

  • Coded ambulatory visits

    • ESSENCE

    • “DNBI”

  • Laboratory results

    • Surges from a site

    • Unusual results


Data sources cont d2
Data Sources (cont’d)

Cumulative AF Influenza Vaccination

  • Local public health officer reports

  • Coded ambulatory

    • ESSENCE

    • “DNBI”

  • Laboratory results

    • Surges from a site

    • Unusual results

  • Immunization data

    • Individual level


Nhrc ve data
NHRC VE Data

  • Existing data from surveillance program

    • Trainees at 4 training bases

    • December 2003

  • Influenza culture positives only

  • Person-time analysis

    • Weeks at risk

    • Vaccinated vs. unvaccinated (2 wks post vax)

  • Basic trainees are vaccinated upon arrival


Nhrc data cont d
NHRC data (cont’d)


Ve calculation

AR vax = 4 cases / 54278 person-wks

7.37/100,000 person-wks

AR unvax = 15 cases / 18617 person-wks

80.6/100,000 person-wks

RR = 7.37 / 80.6 = 0.0914

VE = 1 – RR = 90.9%

VE calculation


Ft lee virginia
Ft Lee, Virginia

  • US Army post - Quartermaster Training

    • 3,200 trainees; courses of varying length; 12%/week turnover

  • Influenza outbreak, 31 Oct-11 Nov 2003


Ft lee ili epi curve
Ft. Lee ILI Epi Curve

Mass Immunizations

CHPPM/WRAIR EPICON


Ft lee virginia1
Ft Lee, Virginia

  • US Army post - Quartermaster Training

    • 3,200 trainees; courses of varying length; 12%/week turnover

  • Influenza outbreak, 31 Oct-11 Nov 2003

  • PH response: mass immunization, case isolation

  • Vaccine Effectiveness Study Attempt

    • 2 cohorts

    • “tight” and “loose” case definition

    • Limitations – temporality, highly immunized population, exhaustion of susceptibles, random mixing assumption



Af ive evaluation plan a

Identify exposed cohort (AF only, not Academy)

Index cases: influenza culture positive in AFIOH lab

Contact sponsor for household health histories

Influenza vaccinations

Febrile respiratory illnesses within 2 wks of index case

Calculate secondary attack rate

Compare vaccinated and unvaccinated

IRB approved; telephone surveys began 2 Feb 2004

results pending

Annual routine study?

AF IVE Evaluation: Plan A

# specimens=2459

# positive = 859

# eligible = 114

Total # of family members=400


Af ive evaluation plan b

Identify site with ongoing transmission

Lab submissions, ESSENCE, other reports

Index cases: influenza culture positive in AFIOH lab

Decision: Launch on-site investigation vs. telephone only

Surveillance data sources to assess extent of local outbreak

Contact sponsor/parent directly for household health histories

Influenza vaccination history

Febrile respiratory illness within 2 wks of index case

Validate data with medical records, vaccination registry, labs

Use secondary attack rates to estimate VE

Annual routine study?

Pending IRB & AF approval

AF IVE Evaluation: Plan B


Summary

NHRC: VE = 91%

CHPPM: VE = 40-100%

AF: VE = pending

Many details . . .

Summary


Questions

Contact information:

Col James Neville, MD, MPH

E-mail: [email protected]

Phone: 210-536-2002



Specimen results by week of training
Specimen Results by Week of Training




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