Seasonal influenza vaccine effectiveness in people with asthma : a national test-negative design case-control study

Vasileiou, Eleftheria and Sheikh, Aziz and Butler, Chris C and Robertson, Chris and Kavanagh, Kimberley and Englishby, Tanya and Lone, Nazir I and von Wissmann, Beatrix and McMenamin, Jim and Ritchie, Lewis D and Schwarze, Jürgen and Gunson, Rory and Simpson, Colin R (2019) Seasonal influenza vaccine effectiveness in people with asthma : a national test-negative design case-control study. Clinical Infectious Diseases. ISSN 1058-4838 (

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Background Influenza infection is a trigger of asthma attacks. Influenza vaccination can potentially reduce the incidence of influenza in people with asthma, but uptake remains persistently low, partially reflecting concerns about vaccine effectiveness (VE). Methods We conducted a test-negative designed case-control study to estimate the effectiveness of influenza vaccine in people with asthma in Scotland over 6 seasons (2010/2011 to 2015/2016). We used individual patient–level data from 223 practices, which yielded 1 830 772 patient-years of data that were linked with virological (n = 5910 swabs) data. Results Vaccination was associated with an overall 55.0% (95% confidence interval [CI], 45.8–62.7) risk reduction of laboratory-confirmed influenza infections in people with asthma over 6 seasons. There were substantial variations in VE between seasons, influenza strains, and age groups. The highest VE (76.1%; 95% CI, 55.6–87.1) was found in the 2010/2011 season, when the A(H1N1) strain dominated and there was a good antigenic vaccine match. High protection was observed against the A(H1N1) (eg, 2010/2011; 70.7%; 95% CI, 32.5–87.3) and B strains (eg, 2010/2011; 83.2%; 95% CI, 44.3–94.9), but there was lower protection for the A(H3N2) strain (eg, 2014/2015; 26.4%; 95% CI, −12.0 to 51.6). The highest VE against all viral strains was observed in adults aged 18–54 years (57.0%; 95% CI, 42.3–68.0). Conclusions Influenza vaccination gave meaningful protection against laboratory-confirmed influenza in people with asthma across all seasons. Strategies to boost influenza vaccine uptake have the potential to substantially reduce influenza-triggered asthma attacks.


Vasileiou, Eleftheria, Sheikh, Aziz, Butler, Chris C, Robertson, Chris, Kavanagh, Kimberley ORCID logoORCID:, Englishby, Tanya, Lone, Nazir I, von Wissmann, Beatrix, McMenamin, Jim, Ritchie, Lewis D, Schwarze, Jürgen, Gunson, Rory and Simpson, Colin R;