Impact of accounting for correlation between COVID-19 and influenza vaccination in a COVID-19 vaccine effectiveness evaluation using a test-negative design

Amanda B Payne; Allison Avrich Ciesla; Elizabeth A K Rowley; Zachary A Weber; Sarah E Reese; Toan C Ong; Gabriela Vazquez-Benitez; Allison L Naleway; Nicola P Klein; Peter J Embi; Shaun J Grannis; Anupam B Kharbanda; Manjusha Gaglani; Mark W Tenforde; Ruth Link-Gelles; VISION Network

doi:10.1016/j.vaccine.2023.11.025

Impact of accounting for correlation between COVID-19 and influenza vaccination in a COVID-19 vaccine effectiveness evaluation using a test-negative design

Vaccine. 2023 Dec 12;41(51):7581-7586. doi: 10.1016/j.vaccine.2023.11.025. Epub 2023 Nov 23.

Authors

Affiliations

¹ National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: [email protected].
² National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA; Eagle Health Analytics, San Antonio, TX, USA.
³ Westat, Rockville, MD, USA.
⁴ School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
⁵ HealthPartners Institute, Minneapolis, MN, USA.
⁶ Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA.
⁷ Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, CA, USA.
⁸ Vanderbilt University Medical Center, Nashville, TN, USA.
⁹ Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA.
¹⁰ Children's Minnesota, Minneapolis, MN, USA.
¹¹ Section of Pediatric Infectious Diseases, Center for Research in Vaccines and Infections, Baylor Scott & White Health and Baylor College of Medicine, Temple, TX, USA; Texas A&M University College of Medicine, Temple, TX, USA.
¹² National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
¹³ National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA; United States Public Health Service Commissioned Corps, Rockville, MD, USA.

PMID: 38000964
DOI: 10.1016/j.vaccine.2023.11.025

Abstract

Test-negative-design COVID-19 vaccine effectiveness (VE) studies use symptomatic SARS-CoV-2-positive individuals as cases and symptomatic SARS-CoV-2-negative individuals as controls to evaluate COVID-19 VE. To evaluate the potential bias introduced by the correlation of COVID-19 and influenza vaccination behaviors, we assessed changes in estimates of VE of bivalent vaccines against COVID-19-associated hospitalizations and emergency department/urgent care (ED/UC) encounters when considering influenza vaccination status or including or excluding influenza-positive controls using data from the multi-state VISION vaccine effectiveness network. Analyses included encounters during October 2022 - February 2023, a period of SARS-CoV-2 and influenza cocirculation. When considering influenza vaccination status or including or excluding influenza-positive controls, COVID-19 VE estimates were robust, with most VE estimates against COVID-19-associated hospitalization and ED/UC encounters changing less than 5 percentage points. Higher proportions of influenza-positive patients among controls, influenza vaccination coverage, or VE could impact these findings; the potential bias should continue to be assessed.

Keywords: COVID-19; Influenza; Negative; SARS-CoV-2; Test; Vaccine effectiveness.

Published by Elsevier Ltd.

MeSH terms

COVID-19 Vaccines
COVID-19* / prevention & control
Humans
Influenza Vaccines*
Influenza, Human* / prevention & control
SARS-CoV-2
Vaccination
Vaccine Efficacy

Substances

COVID-19 Vaccines
Influenza Vaccines