.

.

.Overall (I-squared = 0.0%, p = 0.677)

A(H3N2)

2012_13

Subtotal (I-squared = 0.0%, p = 0.476)

A(H1N1)pdm09

2013_14

Subtotal (I-squared = 0.0%, p = 0.472)

Strain

2014_15

A(H1N1)pdm09

A(H3N2)

A(H3N2)

B/YamagataSubtotal (I-squared = 0.0%, p = 0.653)

A(H1N1)pdm09

B/Yamagata

B/Yamagata

31.93 (23.56, 40.31)

28.00 (-8.00, 50.00)

37.93 (22.26, 53.60)

23.00 (-26.00, 53.00)

25.93 (13.96, 37.90)

effectiveness (95% CI)

38.00 (14.00, 55.00)

30.00 (-37.00, 64.00)

21.00 (5.00, 34.00)

43.00 (17.00, 60.00)37.39 (19.71, 55.08)

45.00 (-32.00, 78.00)

Vaccine

35.00 (8.00, 54.00)

61.00 (-3.00, 86.00)

31.93 (23.56, 40.31)

28.00 (-8.00, 50.00)

37.93 (22.26, 53.60)

23.00 (-26.00, 53.00)

25.93 (13.96, 37.90)

effectiveness (95% CI)

38.00 (14.00, 55.00)

30.00 (-37.00, 64.00)

21.00 (5.00, 34.00)

43.00 (17.00, 60.00)37.39 (19.71, 55.08)

45.00 (-32.00, 78.00)

Vaccine

35.00 (8.00, 54.00)

61.00 (-3.00, 86.00)

0-25-50 0 20 50

Influenza Vaccine Effectiveness

050

100

150

200

250

Adm

issi

ons

(n) w

ith in

fluen

za

2012

-45

2012

-46

2012

-47

2012

-48

2012

-49

2012

-50

2012

-51

2012

-52

2013

-01

2013

-02

2013

-03

2013

-04

2013

-05

2013

-06

2013

-07

2013

-08

2013

-09

2013

-10

2013

-11

2013

-12

2013

-13

2013

-14

2013

-15

2013

-16

2013

-17

2013

-18

2013

-19

2013

-20

2013

-21

2013

-22

2013

-23

2013

-49

2013

-50

2013

-51

2013

-52

2014

-01

2014

-02

2014

-03

2014

-04

2014

-05

2014

-06

2014

-07

2014

-08

2014

-09

2014

-10

2014

-11

2014

-12

2014

-13

2014

-14

2014

-15

2014

-16

2014

-17

2014

-18

2014

-19

2014

-20

2014

-21

2014

-22

2014

-23

2014

-40

2014

-41

2014

-42

2014

-43

2014

-44

2014

-45

2014

-46

2014

-47

2014

-48

2014

-49

2014

-50

2014

-51

2014

-52

2014

-53

2015

-01

2015

-02

2015

-03

2015

-04

2015

-05

2015

-06

2015

-07

2015

-08

2015

-09

2015

-10

2015

-11

2015

-12

2015

-13

2015

-14

2015

-15

2015

-16

2015

-17

2015

-18

2015

-19

2015

-20

2015

-21

Week

A(H1N1)pdm09 (n=1,082) A(H3N2) (n=2,012) A nosubtyped (n=247)B/Yamgata-lin (n=1,168) B/Victoria-lin (n=61) B nosubtyped (n=181)

Global  Influenza  Surveillance  Network,  epidemiology  and  influenza  vaccine  effec=veness,  in  three  influenza  seasons,  2012-­‐2015  

The  study  was  funded  by  Sanofi  Pasteur  

Joan Puig-Barberà1, Anna Sominina2, Elena Burtseva3, Hongjie Yu4, Meral A. Ciblak5, Odile Launay6, Jan Kyncl7, Angels Natividad-Sancho1, Maria Pisareva2, Svetlana Trushakova3, Benjamin J. Cowling8, Selim Badur5, Philippe Vanhems9, Helena Jirincova7, Ainara Mira-Iglesias1, Elizaveta Smorodintseva2, Lyudmila Kolobukhina3, Feng Luzhao4, Kubra Yurctu5, Nezha Lenzi6, Zdenka Mandakova7, for the Global

Influenza Hospital Surveillance Study Group (GIHSN)

1 Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain; 2 Research Institute of Influenza, Saint Petersburg, Russian Federation; 3 D.I. Ivanovsky Institute of Virology FGBC “N.F. Gamaleya FRCEM ”Ministry of Health of Russian Federation, Moscow, Russian Federation; 4 Division of Infectious Disease, Key Laboratory of Surveillance and Early-Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China; 5 National Influenza Reference Laboratory,

Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey; 6 Université Paris Descartes, Sorbonne Paris Cité, Inserm, CIC 1417 and the French Vaccine Research Network (REIVAC), Paris, France.; 7 Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic; 8 School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; 9 Edouard Herriot Hospital, Lyon University Hospital (Hospices Civils de Lyon), Lyon, FranceLenzi6, Zdenka

Mandakova7, for the Global Influenza Hospital Surveillance Study Group (GIHSN)

Abstract  :  AOIX00541  

Influenza  vaccine  effec=veness  in  preven=ng  admissions  with  influenza  was  low  to  moderate.  While  influenza  vaccina=on  is  to  be  recommended  for  preven=ng  influenza  related  disease,  improved  vaccines  that  offer  beMer  protec=on  are  needed.  

Results    

Background

During  its  first  three  consecu/ve  influenza  seasons,  2012/13,  2013/14  and  2014/15  field  researchers  in  par/cipa/ng  GIHSN  hospitals  ac/vely  screened  consecu/ve   admissions   possibly   related   to   influenza   using   a   common  protocol.  Depending  on  the  season,  par/cipa/ng  hospitals  were   in  Russia,  China,  the  Czech  Republic,  France,  Turkey  and  Spain.  

 Fundación  para  el  Fomento  de  la  Inves=gación  Biomédica  y  Sanitaria  (FISABIO),  Valencia,  Spain  Phone:  +34  961  925  968;  e-­‐mail:  puig_joa@gva.es  

hWp://gihsn.org/    

Methods

Keywords:  Influenza,  Influenza  vaccine  and  Epidemiology      

Conclusion

ARer  consent,  we  collected  informa/on  on  socio  demographic  and  clinical  characteris/cs   and   obtained   nasal,   pharyngeal   or   nasopharyngeal   swabs  and   ascertained   influenza   virus   subtype   or   lineage   with   reverse  transcrip/on  polymerase  chain  reac/on   (RT-­‐PCR).  The  adjusted  odds  ra/o  (aOR)   for   admission   with   influenza   related   to   strain   and   various   pa/ent  characteris/cs   was   es/mated   with   mul/level   mul/variate   logis/c  regression  taking  into  account  calendar  /me  and  country  clustering  effect.  Vaccine effectiveness was estimated as (1-aOR)*100.  

We   speculate   that   influenza   circula/on   variability   could   be   related   to  evolving   immunity   in   the   popula/on   and   virus   adaptability   to   this   ecologic  background.  Whereas   the   level  of   vaccine  effec/veness   could  be   related   to  this   background   immunity   and   the   driR   of   the   virus   that   could   possibly   be  related  to  its  gene/c  characteris/cs.  

Figure  1.  Admissions  with  influenza  by  season  and  week. Figure  2.  Influenza  vaccine  effec/veness  

41,288  pa/ents  were  screened,  35,547  were  considered  eligible,  21,872  met  criteria   for   inclusion   and   had   valid   laboratory   results.   Finally,   4,698   (21%)  were  influenza  posi/ve.  

Vaccina/on  provided  low  to  moderate  protec/on  against  hospital  admission  with   laboratory   –confirmed   influenza   in   adults   targeted   for   influenza  vaccina/on.    GIHSN   can   fill   a   relevant   gap   in   our   understanding   of   influenza,   given   the  opportunity   of   collabora/on   among   different   teams,   the   geographic  representa/ve   surveillance   on   admissions   with   influenza   and   vaccine  performance.  

 Fundación  para  el  Fomento  de  la  Inves4gación  Biomédica  y  Sanitaria  (FISABIO),  Valencia,  Spain  Phone:  +34  961  925  968;  e-­‐mail:  puig_joa@gva.es  hRp://gihsn.org/    

Waning  protec-on  of  influenza  vaccina-on.  A  test-­‐nega-ve  study  in  four  consecu-ve  influenza  seasons.  Valencia  Hospital  Network  for  the  Study  of  Influenza  (VAHNSI),  Spain.  

VAHNSI  ac4vity  is  partly  funded  by  Sanofi  Pasteur  

Joan Puig-Barberà1,2, Ainara Mira-Iglesias1, Miguel Tortajada-Girbés3, F. Xavier López-Labrador1,4, Ángel Belenguer-Varea5, Mario Carballido-Fernández6, Empar Carbonell-Franco7, Concha Carratalá-Munuera8,9 Ramón Limón-Ramírez10, Joan Mollar-Maseres11, Maria del Carmen Otero-Reigada11, Germán Schwarz-Chavarri12, José Tuells13, Vicente Gil-Guillén9,14, * for the Valencia Hospital Network for the

Study of Influenza and other Respiratory Viruses (VAHNSI)

1. Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Valencia, Spain; 2. Centro de Salud Pública de Castellón, Castellón, Spain; 3. Hospital Doctor Peset, Valencia, Spain; 4. Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; 5. Hospital de La Ribera, Alzira, Spain; 6. Hospital General de Castellón, Spain; 7. Hospital Arnau de Vilanova, Valencia, Spain; 8. Hospital San Juan, Alicante, Spain; 9. Cátedra de Medicina de

Familia. Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan, Alicante, Spain; 10. Hospital de la Plana, Vila-real, Spain; 11. Hospital Universitario y Politécnico La Fe, Valencia, Spain; 12. Hospital General de Alicante, Alicante, Spain; 13. Hospital Universitario del Vinalopó, Elche, Spain; 14. Hospital de Elda, Elda, Spain Disease Control and Prevention, Beijing, China; 6 School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China

Abstract  :  AOIX00065  

Annual influenza vaccination is recommended to prevent influenza related complications. There exists an ongoing debate regarding the waning of vaccine protection. We present our results on the relationship of date of vaccination (DOV) with admission with influenza in four consecutive influenza seasons.

We explored if DOV could be explained by age, sex, underlying chronic conditions, previous influenza vaccination, smoking habits, socioeconomic status, previous general practitioner (GP) consultations or hospital admissions. We used a test-negative approach to compare the adjusted odds ratio (aOR) of admissions with influenza and vaccination in the third DOV tertile, with the first DOV tertile as reference, overall, by predominant strain and restricting the analysis only to admissions in 65 years old and older. OR were estimated by a multilevel logistic regression approach adjusted by age, gender, smoking habits, social class, number of chronic conditions, being hospitalized in the last year, GP consultations, days from onset of symptoms to swabbing, calendar time (weeks) in restricted cubic splines and hospital as a random effect. A sensitivity analysis was performed in individuals vaccinated both in the past and current season.

Keywords:  Influenza  vaccine,  waning  effect  and  Epidemiology      

Consenting consecutive admissions were included and swabbed. Influenza infection and subtyping was performed by real time reverse transcription polymerase chain reaction (RT-PCR). Only vaccinated patients were included. The study was conducted in four consecutive seasons in the Valencia Region (Figure 1), located in the Eastern Mediterranean coast of Spain, Valencia Region population is 5 million inhabitants. The Valencia network included nine, five, six and ten hospitals in the 2011/12, 2012/13, 2013/14 and 2014/15 seasons, in which we enrolled 1127, 520, 633 and 1599 18 years old and older subjects, belonging to target groups for vaccination, and registered as vaccinated with the seasonal influenza vaccine in Valencia’s Vaccination Information System.

Background

Methods

Figure  1:  Par?cipa?ng  Health  Districts  (hospitals)  and  popula?on.  

Conclusion

Waning effect was observed in two mismatched A(H3N2) predominant seasons (11/12 and 14/15). Sparse numbers precluded other analysis by age group, strain or in those vaccinated only in the current season.

Results We ascertained 293, 68, 106 and 357 admissions with influenza in vaccinated patients in 2011/12, 2012/13, 2013/14 and 2014/15 seasons (Figure 2).

Season 2011/12

0

50

100

150

200

250

300

350

2011

-39

2011

-41

2011

-43

2011

-45

2011

-47

2011

-49

2011

-51

2012

-01

2012

-03

2012

-05

2012

-07

2012

-09

2012

-11

2012

-13

2012

-15

Epidemiological week

0

10

20

30

40

50

60

70

Season 2013/14

0

50

100

150

200

250

2013

-39

2013

-41

2013

-43

2013

-45

2013

-47

2013

-49

2013

-51

2014

-01

2014

-03

2014

-05

2014

-07

2014

-09

2014

-11

2014

-13

2014

-15

Epidemiological week

0

2

4

6

8

10

12

14

16

18

20

Season 2012/13

0

20

40

60

80

100

120

140

160

180

200

2012

-39

2012

-41

2012

-43

2012

-45

2012

-47

2012

-49

2012

-51

2013

-01

2013

-03

2013

-05

2013

-07

2013

-09

2013

-11

2013

-13

2013

-15

Epidemiological week

0

2

4

6

8

10

12

Season 2014/15

0

100

200

300

400

500

600

700

2014

-39

2014

-41

2014

-43

2014

-45

2014

-47

2014

-49

2014

-51

2014

-53

2015

-02

2015

-04

2015

-06

2015

-08

2015

-10

2015

-12

2015

-14

Epidemiological week

0

10

20

30

40

50

60

Vaccination week negativesVaccination week positivesB not subtyped B Victoria B Yamagata A not subtyped H3N2 H1N1

Figure  2:  Distribu?on  of  vaccina?on  date  with  RT-­‐PCR  result  and  distribu?on  of  influenza  strains  by  season.  

Health  department   Population   Seasons  General  Castellón   277672   11/12,  12/13,  13/14,  14/15  La  Plana   185686   11/12,  12/13,  13/14,  14/15  Arnau  de  Vilanova   255648   11/12,  14/15  La  Fe   192572   11/12,  13/14,  14/15  Doctor  Peset   359893   11/12,  12/13,  13/14,  14/15  La  Ribera   259125   14/15  San  Juan   212894   11/12,  12/13,  13/14,  14/15  Elda   190389   11/12,  12/13,  13/14,  14/15  General  Alicante   264490   11/12,  14/15  Vinalopó   153157   14/15  TOTAL   2351526    

We observed a higher risk of admission with influenza in those individuals vaccinated at the beginning of the vaccination campaign in the 2011/12 season (aOR=0.68, 95%CI=0.47 to 0.99 of DOV third tertile compared to DOV first tertile) and in the 2014/15 season (aOR=0.68, 95%CI=0.49 to 0.93). Nevertheless, we did not find differences on vaccine protection by DOV tertile in the 2012/13 season (aOR=1.17, 95%CI=0.57 to 2.37) and in the 2013/14 season (aOR=0.94, 95%CI=0.55 to 1.62). Similar estimates were obtained in the sensitivity analysis including only those vaccinated both in the current and previous seasons (Figure 3).

Season 11/12Overall65 years old or olderPredominant strainPredominant strain in 65 years old or olderVaccinated previous and current seasonVaccinated previous and current season in 65 years old or olderSubtotal (I-squared = 0.0%, p = 0.990)

Season 12/13Overall65 years old or olderPredominant strainPredominant strain in 65 years old or olderVaccinated previous and current seasonVaccinated previous and current season in 65 years old or olderSubtotal (I-squared = 0.0%, p = 0.999)

Season 13/14Overall65 years old or olderPredominant strainPredominant strain in 65 years old or olderVaccinated previous and current seasonVaccinated previous and current season in 65 years old or olderSubtotal (I-squared = 0.0%, p = 0.980)

Season 14/15Overall65 years old or olderPredominant strainPredominant strain in 65 years old or olderVaccinated previous and current seasonVaccinated previous and current season in 65 years old or olderSubtotal (I-squared = 0.0%, p = 0.992)

analysisSensitivity

0.68 (0.47, 1.00)0.61 (0.41, 0.91)0.68 (0.46, 1.00)0.60 (0.40, 0.90)0.71 (0.48, 1.05)0.64 (0.42, 0.96)0.65 (0.56, 0.77)

1.17 (0.57, 2.37)1.14 (0.54, 2.44)0.95 (0.38, 2.34)1.18 (0.46, 3.03)1.17 (0.57, 2.40)1.12 (0.52, 2.40)1.13 (0.82, 1.55)

0.94 (0.55, 1.62)0.82 (0.44, 1.54)1.12 (0.59, 2.11)1.19 (0.54, 2.58)0.97 (0.54, 1.72)1.01 (0.53, 1.93)0.99 (0.76, 1.27)

0.68 (0.49, 0.93)0.67 (0.47, 0.94)0.63 (0.45, 0.89)0.61 (0.43, 0.88)0.61 (0.43, 0.86)0.69 (0.49, 0.98)0.65 (0.56, 0.75)

Ratio (95% CI)Adjusted Odds

0.68 (0.47, 1.00)0.61 (0.41, 0.91)0.68 (0.46, 1.00)0.60 (0.40, 0.90)0.71 (0.48, 1.05)0.64 (0.42, 0.96)0.65 (0.56, 0.77)

1.17 (0.57, 2.37)1.14 (0.54, 2.44)0.95 (0.38, 2.34)1.18 (0.46, 3.03)1.17 (0.57, 2.40)1.12 (0.52, 2.40)1.13 (0.82, 1.55)

0.94 (0.55, 1.62)0.82 (0.44, 1.54)1.12 (0.59, 2.11)1.19 (0.54, 2.58)0.97 (0.54, 1.72)1.01 (0.53, 1.93)0.99 (0.76, 1.27)

0.68 (0.49, 0.93)0.67 (0.47, 0.94)0.63 (0.45, 0.89)0.61 (0.43, 0.88)0.61 (0.43, 0.86)0.69 (0.49, 0.98)0.65 (0.56, 0.75)

Ratio (95% CI)Adjusted Odds

1.5 .75 1 2 3

Adjusted odds ratio

Adjusted Odds Ratio <1.00 favours waning of vaccination effect

Figure  3.  Adjusted  odds  ra?o  of  admission  with    laboratory  confirmed  influenza  (RT-­‐PCR)  in  pa?ents  with  later   date   of   vaccina?on   (third   ter?le)   compared   to   those   with   and   earlier   date   of   vaccina?on   (first  ter?le).  

Num

ber v

acci

nate

d N

umbe

r vac

cina

ted

Num

ber v

acci

nate

d N

umbe

r vac

cina

ted

Num

ber i

nflu

enza

pos

itive

ad

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sion

s by

stra

in

Number influenza positive admissions by strain

Num

ber i

nflu

enza

pos

itive

ad

mis

sion

s by

stra

in

Num

ber i

nflu

enza

pos

itive

ad

mis

sion

s by

stra

in

Turkey;  1221;  7%

Valencia;  9318;  56%

Fortaleza;  427;  3%St.  Petersburg;  5618;  

34%

Admissions  with  influenza  and  other  respiratory  viruses,  2012  to  2015  seasons.  Results  from  the  Global  Influenza  Hospital  Surveillance  Network  (GIHSN).  

This  network  ac/vity  is  partly  funded  by  Sanofi  Pasteur  

Joan Puig-Barberà1, Maria Pisareva2, Marilda Siqueira3, Selim Badur4, F. Xavier López-Labrador1,5, Fernanda Edna-Moura6, Ayse Tulay Bagci Bossi7, Ainara Mira-Iglesias1, Veronica Afanasieva2, Sonia Raboni8, Sevim Mese4, Anna Sominina2, for the Global Influenza Hospital Surveillance Study Group (GIHSN)

1 Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain; 2 Research Institute of Influenza, Saint Petersburg, Russian Federation ;3 Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil ;4 National Influenza Reference Laboratory, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey; 5 Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; 6. Universidade Federal de Cearà, Fortaleza, Brazil; 7.

Hacettepe University, Faculty of Medicine, Department of Public Health, Ankara, Turkey; 8. Hospital de Clinicas/Universidade Federal do Paraná, Curitiba, Brazil.

Abstract  :  AOIX00515  

Background

The   Global   Influenza   Hospital   Surveillance   Network   (GIHSN)   is   a   plaCorm  able   to   generate   relevant   data   to   understand   and   define   the   burden   of  disease  related  to  influenza  and  other  respiratory  viruses  (IORV).  Admissions  with  respiratory  viral   infec/on  are  however  not  well  described  although   it   is   accepted   that   they   generate   every   year   a   significant   public  health  problem.    

Whereas,   50-­‐52%   of   IORV   posi/ves   were   observed   in   those   under   5  years  old,  18-­‐27%  of  IORV  posi/ves  were  among  those  65  years  old  or  older.  The  virus  type  distribu/on  was  age-­‐dependent.  

 Fundación  para  el  Fomento  de  la  Inves4gación  Biomédica  y  Sanitaria  (FISABIO),  Valencia,  Spain  Phone:  +34  961  925  968;  e-­‐mail:  puig_joa@gva.es  

hRp://gihsn.org/    

Keywords:  Influenza,  Influenza  vaccine  and  Epidemiology      

Consecu/ve   consen/ng   admissions  with   symptoms  possibly   related   to   an  acute  viral  respiratory  infec/on  presen/ng  within  seven  days  of  symptoms  onset   were   enrolled   and   swabbed   at   GIHSN   sites.   The   presence   of   IORV  was  assessed  by  real  /me  reverse  transcrip/on  polymerase  chain  reac/on  in   Russia   (St.   Petersburg,   three   seasons),   Turkey   (two   seasons),   Spain  (Valencia,  three  seasons)  and  Brazil  (Fortaleza,  one  season).  Overall,  16,584  admissions  were  tested  for  the  presence  of  IORV.  

Figure  1:    Map  of  the  GIHSN  network  in  the  current  season  (2015/2016).  

Methods

Figure  2:    Admissions  with  laboratory  result  by  site.  

A(H1N1);  664;  10%

A(H3N2);  1240;  18%

A  not  subtyped;  155;  2%

B/Yamagata;  664;  10%

B/Victoria;  27;  0%

B  not  subtyped;  17;  0%RSV;  1400;  21%CoV;  398;  6%

HMPV;  206;  3%

AdV;  262;  4%

BoV;  118;  2%

PIV;  163;  2%

RhV/enterovirus;  921;  13%

mixed  infection;  649;  9%

We   ascertained   6,884   (41%)   IORV   posi/ves.   Predominant   viruses   were  influenza  (40%),  RSV  (21%)  and  rhinovirus/enterovirus  (13%).  

Results

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0 - <5 yrs 5 - <18 yrs 18 - <65 yrs >=65 yrs

Mixed influenza infectionMixed respiratory infectionRhinovirusParainfluenzaBocavirusAdenovirusMetapneumovirusCoronavirusRSVB not subtypedB/VictoriaB/YamagataA not subtypedA(H3N2)A(H1N1)

Figure  4:    Virus  distribu/on  by  age  groups.  

Figure  3:  Respiratory  viruses  distribu/on.  Seasons  2012/13  to  2014/15.  

Conclusion The  results  from  this  mul/center  surveillance  further  confirm  the  relevance  of      IORV  infec/on  worldwide.  

Figure  5:    Seasonal  distribu/on  of  the  probability  of  admission  with  IORV  in  the  GIHSN  sites  in  three  consecu/ve  seasons.  

Respiratory syncytial virus (RSV) was dominant in those less than five years old (Figure 4), mostly in 0 to less than 6 months of age (data not shown). In subjects 65 years old and over A(H3N2) was dominant (Figure 4) with 30% or more positives, with its frequency increasing with age (data not shown). In the 65 years old and over, 10% of admissions were positive for RSV, with a decreasing trend by age (Figure 4). There was substantial seasonal variability in the predominance of IORV in included admissions (Figure 5).

T h e G l o b a l I n f l u e n z a H o s p i t a l S u r ve i l l a n c e N e t wo r k a s a g row i n g p l a t fo r m t o g e n e r a t ee p idemio logy ev id ence o n the bu rden o f seve re in f luenza and o the r re sp i ra to r y v i r u sesSophie Druelles1, Clotilde El Guerche-Séblain1,2, Joan Puig-Barberá3, Anna Sominina4, Elena Burtseva5, Jan Kyncl6, Serhat Unal7, Ben Cowling8, Yu Hongjie9, Odile Launay10, Parvaiz Koul11, Guillermo Ruiz-Palacios12, Marilda Siqueira13, Shelly McNeil14, Cédric Mahé1,2, Bruno Lina15 , John Paget16

1Sanofi Pasteur, Global Epidemiology Department, Lyon, France; 2Foundation for Influenza Epidemiology, Lyon, France; 3Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain; 4Research Institute of Influenza of the Ministry of Healthcare of the Russian Federation, WHO National Influenza Centre of Russia, Saint Petersburg, Russia ; 5IvanovskyResearch Institute of Virology, Moscow, Russia ; 6National Institute of Public Health (NIPH), Praha, Czech Republic; 7Turkish Society of Internal Medicine, Ankara, Turkey; 8University of Hong Kong, Hong Kong; 9Chinese Centre for Disease Control and Prevention, Beijing, China; 10i-REIVAC (Innovative Clinical Research Network in Vaccinology), Paris, France; 11Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar,India; 12Mexico National Institutes of Health and High Speciality Hospitals Surveillance Network, Mexico; 13Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil; 14Canadian Center for Vaccinology, Halifax, Canada; 15Centre National de Référence de la Grippe, HCL & UCBL, Lyon, France; 16Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands

Results of each season and pooled analyses are presented at the GIHSN Global Annual Meeting each year in the presence of influenza expertsand representatives from international institutions involved in epidemiology surveillance.

Results are regularly published in scientific journals and available on www.gihsn.org.

The GIHSN studies were conducted in 4, then 5 and finally 6 countries during the 2012-2013, 2013-2014 and 2014-2015 influenza seasons. The network currently includes more than 40 hospitals in 10 countries and the number of samples has increased by 62% from 2012 to 2015.

RESULTS

Option IX for the control of influenza - 24-28 August 2016, Chicago, USACorresponding author: Sophie Druelles, sophie.druelles@sanofipasteur.com

The GIHSN is an international public-private partnership initiated by Sanofi Pasteur. It is

coordinated by a regional public health foundation, FISABIO (Spain), and composed of several

country partners affiliated with National Health Authorities.

This is a multi-centre, prospective, active surveillance, hospital-based epidemiological study. A

standard protocol is shared between sites allowing comparison and pooling of results between sites.

When vaccine coverage is sufficient, vaccine effectiveness is assessed using a test negative design.

The sustainability of the GIHSN has recently been reinforced by the creation of the Foundation for

Influenza Epidemiology in September 2015, governed by an Executive Committee that meets once

a year to evaluate new proposals that are eligible for funding.

Notwithstanding the funding mechanisms of the Foundation, each study site retains full ownership

of the data.

The GIHSN and the Foundation for Influenza Epidemiology: development of a collaborativeframework● All studies are funded through grants from the Foundation for Influenza Epidemiology

● Coordination activities and technical support is provided by FISABIO, an independent health

institute based in Spain

● GIHSN sites funded by the Foundation are invited to share data generated during the season

with FISABIO to produce the pooled analysis presented at the annual meeting

● This platform is an opportunity to plug additional research components such as other respiratory

viruses

Every year, the Foundation for Influenza Epidemiology supports projects aligned with the GIHSN

mission. Non-profit organizations that could coordinate a pool of hospitals in joining the GIHSN are

eligible to respond to a call for proposal for funding, launched in May.

METHODSBackground: Very few hospital-based surveillance systems offer

standardized common core protocols over a broad geographical area

and there is a need to produce reliable influenza burden estimates.

To fill this gap, the Global Influenza Hospital Surveillance Network

(GIHSN) was initiated in 2011 and is now expanding.

Methods: The GIHSN is an international public-private partnership

initiated by Sanofi Pasteur. It is coordinated by a regional public

health foundation, FISABIO (Spain), and composed of several

country partners affiliated with National Health Authorities. Results of

each season and pooled analyses are presented at the GIHSN

Global Annual Meeting each year in the presence of influenza experts

and representatives from international institutions involved in

epidemiology surveillance.

The sustainability of the network has recently been reinforced by the

creation of the Foundation for Influenza Epidemiology in September

2015, governed by an Executive Committee that meets once a year

to evaluate new proposals that are eligible for funding. The

Foundation is an opportunity to facilitate additional funding from

external donors (private and public) and it supports not-for-profit

organizations able to coordinate a pool of hospitals with

epidemiological research projects aligned with the GIHSN mission.

As well as supporting the GIHSN influenza studies, it represents a

new and growing platform to develop research on the epidemiology

of other respiratory viruses. Notwithstanding the funding mechanisms

of the Foundation, each study site retains full ownership of the data.

Results: The GIHSN studies were conducted in 4, then 5 and finally

6 countries during the 2012-2013, 2013-2014 and 2014-2015

influenza seasons. The network currently includes more than 40

hospitals in 10 countries and the number of samples tested has

increased by 62% from 2012 to 2015. Results are regularly published

in scientific journals and available on www.gihsn.org.

Conclusions: The enlargement of the GIHSN network is an

opportunity to learn from the variations of epidemiological patterns and

burden of respiratory viruses across regions and to collect more

representative data over time. An increase in the number of GIHSN

partners will enable an increased sample size, thus amplifying the

sensitivity and external validity of the results. Currently there is a need

to expand the GIHSN network to additional Southern Hemisphere

countries, to enable more specific and sensitive comparisons across

sites and seasons.

ABSTRACT

Very few hospital-based surveillance systems offer standardized

common core protocols over a broad geographical area and there is

a need to produce reliable influenza burden estimates. To fill this gap,

the Global Influenza Hospital Surveillance Network (GIHSN) was

initiated in 2011 and is now expanding.

BACKGROUND The enlargement of the GIHSN network is an opportunity to learn from the variations of epidemiological patterns and burden of respiratoryviruses across regions and to collect more representative data over time. An increase in the number of GIHSN partners will enable anincreased sample size, thus amplifying the sensitivity and external validity of the results. Currently there is a need to expand the GIHSNnetwork to additional Southern Hemisphere countries, to enable more specific and sensitive comparisons across sites and seasons.

C O N C L U S I O N S

Quantify thedistribution of thedifferent influenza

viruses among severecases

Evaluate theburden of severeinfluenza disease

Measure theeffectiveness of influenza seasonalvaccines

HOSPITALSURVEILLANCE

NETWORK

The three main scientific objectives of the network

Further informationMore information about the network and description of the implementing partners can be found on the Global Influenza Hospital Surveillance Network website: www.gihsn.org

FOUNDATION FOR INFLUENZAEPIDEMIOLOGY

Governance: Executive Committee9 members (scientific representatives, influenza

experts, representative of external donors)

Support for not-for-profit organizations or institutions able tocoordinate a pool ofhospitals, and with

epidemiologicalresearch projectsaligned with the

GIHSN

New and growingplatform to develop

research onepidemiology of

influenza and otherrespiratory viruses

Opportunity tofacilitate additional

funding from privateand public donors

Main features of the Foundation for Influenza Epidemiology

Role of the institution in the national/regionalinfluenza surveillance

system

Geographicalrepresentativeness

of the site for the GIHSN mission

Scientific relevance ofthe proposal and

the proposed design

On-site laboratorycapacities to testinfluenza strains

by RT-PCR

Experience in conductingepidemiological studies,

in particular similar activesurveillance study

Level of co-fundingfrom the applicant

CRITERIA FORSELECTION OFPROPOSALS

Criteria for the selection of proposals

TurkeyTurkish Society of Internal Medicine

Abc Coordination partnersAbc Implementing partners GIHSN Coordinating Centre

Czech RepublicNational Institute of

Public Health

Ivanovsky Research Institute of virology& Research Institute of Influenza,

WHO NICCanada

Canadian Centrefor Vaccinology

MexicoMexico National Institutes

of Health and HighSpeciality Hospitals

Surveillance Network

Oswaldo Cruz Foundation(FIOCRUZ)

Fondation Mérieux

IndiaSher-i-Kashmir of

Medical Sciences (SKIMS)

ChinaChinese Centre for Disease Control

and PreventionUniversity of Hong Kong

Francei-REIVAC & Fluvac

Sanofi Pasteur

Russia

Brazil

SpainFISABIO

Current partners and implementing sites for the 2015-2016 influenza season

Season Number of Number of Number of Number of Number of countries implementing people included positive influenza positives for other

hospitals for ILI cases respiratory viruses2012-2013 4 21 5,906 1,545 (30.7%) 478 (8.1%)2013-2014 5 24 5,963 1,139 (19.2%) 884 (15.3%)2014-2015 6 27 9,589 2,176 (22.7%) 2,475 (22.2%)

Evolution of the Global Influenza Hospital Network over the seasons