Ellen MacDonald on behalf of

Transcription

1 Ellen MacDonald on behalf of S McNeil, A McGeer, J McElhaney, J Johnstone, V Shinde, D MacKinnon-Cameron, L Ye, A Ambrose and M Andrew on behalf of the Public Health Agency of Canada/Canadian Institutes of Health Research (PCIRN) Serious Outcomes Surveillance (SOS) Network Investigators and the Toronto Invasive Bacterial Diseases Network (TIBDN) Investigators

2 Disclosure Statement The PCIRN (PHAC/CIHR) SOS Network is supported through collaborative research agreements with GlaxoSmithKline Biologicals, SA and Pfizer Inc. No personal financial interests

3 Disclosure of Relationship Disclosure Statement I am a member of an Advisory Board or equivalent with a commercial organization. I am a member of a Speaker Bureau. I have received payment from a commercial organization (including gifts or other consideration or in kind compensation). I hold a patent for a product referred to in the CME/CPD program or that is marketing by a commercial organization I hold a patent for a product referred to in the CME/CPD program or that is marketing by a commercial organization I hold investments in a pharmaceutical organization, medical devices company or communications firms. I am currently participating in or have participated in a clinical trial within the past two years.). Company/Organization

4 Background The goal of Canada s influenza immunization program is prevention of serious complications of influenza including hospitalization and death Influenza B is typically considered to be less severe than Influenza A and little is known about the impact of B lineages in older adults When considering potential benefits of quadrivalent vaccines, understanding the contributions of influenza A and B to serious outcomes will be critical For older adults, frailty (not just age) is key to this discussion

5 Methods 40 sentinel teaching hospitals across Canada active surveillance for influenza infection in adults ( 16 years of age) NP swab obtained from all patients with an admitting diagnosis of CAP, exacerbation of COPD/asthma, unexplained sepsis, any respiratory diagnosis or symptom OR acute coronary syndrome, stroke or any other cardiac diagnosis with fever ( 37.5 C) All NP swabs tested for influenza A & B by PCR

6 The PCIRN SOS Network: 2009: 8 hospitals in 5 provinces, 5000 beds 2010: 10 hospitals in 6 provinces, 6000 beds 2011: 40 hospitals in 7 provinces, 15,000 beds 2012: 45 hospitals in 7 provinces, 18,000 beds 2009 Sites 2010 Sites 2011 Sites 2012 Sites Vancouver Moncton Trois Riviere Saint John Winnipeg Sudbury Quebec City Halifax Montreal Sherbrooke Ottawa Toronto Hamilton Toronto- TIBDN

7 So what does frailty have to do with influenza? Figure credit: Janet McElhaney

8 Frailty: it comes down to Vulnerability Insults Reserve

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10 Frailty (index) better stratifies 70-month survival than does age Survival probability Age FI-CGA Survival time (months) Rockwood, Rockwood, Mitnitski., J Am Geriatrics Soc, 2010;58:

11 So what does frailty have to do with influenza? Understanding the impact of influenza on frailty is critical to understanding its true burden Figure credit: Janet McElhaney

12 Enrollment by Week (2011/12)

13 Overall strain distribution (2011/12) PHAC: FluWatch (n=1443) Figure 6. Influenza strain characterizations, Canada,

14 Assuming our data is representative among hospitalized cases A/H3N2-90% of Canadian strains were related to A/Perth/16/2009 A/H1N1-97% were related to A/California/07/2009 PHAC; FluWatch ~44% OF CASES NOT VACCINE PREVENTABLE (Yamagata lineage)

15 Age and Burden of Disease Age N = 128 Age N = 118 Age N = 109 Age >75 N = 237 % vaccinated BOD by strain Death 1 (0.8%) 3 (2.5%) 6 (5.5%) 36 (15.2%) ICU 16 (12.5%) 20 (16.9%) 17 (15.6%) 22 (9.3%)

16 Frailty and Burden of Disease % vaccinated Low Frailty (FI < 0.2) N = 92 Med Frailty (FI ) N = 84 High Frailty (FI <0.45) N = 14 BOD by strain Death 5 (5.4%) 11 (13.1%) 5 (35.7%) ICU 7 (7.6%) 11 (13.1%) 1 (7.1%)

17 Outcomes by type/subtype (2011/12) Variable Influenza A n = 161 Influenza B n = 299 A/H1N1 n=99 A/H3N2 n=61 B/Vic n=89 Mean LOS (SD) 10.0 (10.4) 10.4 (11.9) B/Yam n= (9.1) 11.0 (12.4) 11.3 (13.2) 10.1 (11.4) Admit to ICU 22 (13.7%) 30 (10.0%) * P (15.2%) 7 (11.5%) 12 (13.5%) 18 (8.8%) 30d mortality 10 (6.2%) 23 (7.7%) 3 (3.0%) 7 (11.5%)* 3 (3.4%) 20 (9.8%)*

18 Key points Influenza B contributes significantly to serious outcomes in adults 44% of hospitalizations were due to non-vaccine-strain B Mortality associated with hospitalization due to influenza B similar to influenza A (7.7% vs 6.2%) Non-vaccine strain influenza B associated with similar mortality rate as A/H3N2 (9.8% vs 11.5%) Given contribution of influenza B to serious outcomes in adults, use of QIV may offer important benefits over TIV in supporting the goal of the Canadian influenza immunization program Frailty was associated with increasing burden of influenza B and serious outcomes Frailty, not just age, is an important consideration in vaccine studies

19 Acknowledgements Many thanks to the SOS Network team! Special thanks to Shelly McNeil (PI) and the dedicated SOS Network surveillance monitors, Ardith Ambrose (SOS Network Project Manager) and Donna MacKinnon- Cameron, Christina Wang, Peter Ye