Influenza vaccination and respiratory virus interference among Department of Defense personnel during the 2017–2018 influenza season
- We examined virus interference in a Department of Defense dependent population.
- Vaccinated personnel did not have significant odds of respiratory illnesses.
- Vaccinated personnel were protected against influenza.
- Odds of virus interference by vaccination varied for individual respiratory viruses.
Receiving influenza vaccination may increase the risk of other respiratory viruses, a phenomenon known as virus interference. Test-negative study designs are often utilized to calculate influenza vaccine effectiveness. The virus interference phenomenon goes against the basic assumption of the test-negative vaccine effectiveness study that vaccination does not change the risk of infection with other respiratory illness, thus potentially biasing vaccine effectiveness results in the positive direction. This study aimed to investigate virus interference by comparing respiratory virus status among Department of Defense personnel based on their influenza vaccination status. Furthermore, individual respiratory viruses and their association with influenza vaccination were examined.
We compared vaccination status of 2880 people with non-influenza respiratory viruses to 3240 people with pan-negative results. Comparing vaccinated to non-vaccinated patients, the adjusted odds ratio for non-flu viruses was 0.97 (95% confidence interval (CI): 0.86, 1.09; p = 0.60). Additionally, the vaccination status of 3349 cases of influenza were compared to three different control groups: all controls (N = 6120), non-influenza positive controls (N = 2880), and pan-negative controls (N = 3240). The adjusted ORs for the comparisons among the three control groups did not vary much (range: 0.46–0.51).
Receipt of influenza vaccination was not associated with virus interference among our population. Examining virus interference by specific respiratory viruses showed mixed results. Vaccine derived virus interference was significantly associated with coronavirus and human metapneumovirus; however, significant protection with vaccination was associated not only with most influenza viruses, but also parainfluenza, RSV, and non-influenza virus coinfections.
Examining 6120 people with respiratory viruses other than influenza and pan-negative results who submitted a respiratory specimen for laboratory testing to the DoDGRS team, those who received an influenza vaccine had a decreased risk of having other respiratory pathogens identified compared to the unvaccinated group. One study in the United States found similar results . The study found influenza vaccination was not associated with detection of non-influenza respiratory viruses . Additionally, the laboratory data in our study showed increased odds of coronavirus and human metapneumovirus in individuals receiving influenza vaccination. The study finding similar results to our study found no association between influenza vaccination and RSV, adenovirus, human metapneumovirus, rhinovirus or coronavirus . The same study did find a significant association between parainfluenza and influenza vaccination, but the association was in opposite directions when comparing children and adults . In our disease specific investigation, virus interference trends were noticed for coronavirus and human metapneumovirus; however, two specific respiratory viruses (parainfluenza and RSV) showed significant protection associated with influenza vaccine receipt, and all others tested (adenovirus, human bocavirus, and rhinovirus/enterovirus) showed protection, although non-significant, associated with vaccination (Table 5). – sciencedirect.com
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…Vaccine derived virus interference was significantly associated with coronavirus and human metapneumovirus…
…Additionally, the laboratory data in our study showed increased odds of coronavirus and human metapneumovirus in individuals receiving influenza vaccination….
…Examining non-influenza viruses specifically, the odds of both coronavirus and human metapneumovirus in vaccinated individuals were significantly higher when compared to unvaccinated individuals (OR = 1.36 and 1.51, respectively)….
Update March 22, 2020: I have added the following calculation.
1.36/(1.36+1.0) ~= 57%
i.e. in this study for the 2017/18 flu season, there was a difference of 7% vs the expected 50% in the vaccinated group, for getting the common cold (a coronavirus) in 2017/18.
The group studied were healthy military personal. I wonder if that 7% would be higher for people with compromised immune systems?
Of course, COVID-19, a coronavirus, was not around in 2017/18 sooo???
1.51/(1.51+1.0) ~= 60%
i.e. in this study for the 2017/18 flu season, there was a difference of 10% vs the expected 50% in the vaccinated group, for getting metapneumovirus in 2017/18.
Key Facts About the metapneumovirus
- hMPV causes upper respiratory infections in people of all ages but is most common in children, particularly under the age of 5.
- Symptoms include runny nose, nasal congestion, cough, sore throat, headache, and fever. A very small number of individuals may have some shortness of breath.
- In most cases, the symptoms go away on their own after a few days.
- A very small number of people are at risk for a more severe pneumonia following this infection, especially those who are over the age of 75 or have compromised immune systems.