Real-world influenza vaccine effectiveness: New designs and methods to adjust for confounding and bias

Darvishian, M. 2016 [Groningen]: University of Groningen. 258 p.

Research output: ScientificThesis fully internal (DIV)

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  • Title and contents

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  • Chapter 1

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  • Chapter 2

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  • Chapter 3

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  • Chapter 4

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  • Chapter 5

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  • Chapter 6

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  • Chapter 7

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  • Chapter 8

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  • Chapter 9

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  • Complete thesis

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  • Propositions

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  • Maryam Darvishian
As recommended by the World Health Organization, seasonal influenza vaccination of high-risk populations (e.g. elderly and individuals with specific chronic medical conditions) is the main preventive strategy against influenza and influenza-related complications. Despite these recommendations, influenza vaccination coverage rates are still generally low which partly could be due to the uncertainties about the real-world effectiveness of seasonal influenza vaccine. Limitations in conducting experimental randomized (placebo-) controlled trials as well as susceptibility of observational study designs to different sources of biases contribute to this ongoing uncertainty. In this thesis we therefore aimed to estimate seasonal influenza vaccine effectiveness (IVE) by means of new study designs and methods to provide more accurate IVE estimates while addressing and/or adjusting for the potential biases and confounders. We found that even after adjusting for different source of biases and potential confounders, influenza vaccine is moderately effective against influenza and influenza related-complications among elderly population. Furthermore, we observed that conventional meta-analysis methods might not provide the best tool to measure pooled IVE estimates and more accurate methods should be considered in the future studies. Finally, we observed extreme variability in IVE estimates depending on influenza virus (sub)types, influenza season, and type of control group that is included in the test-negative design case-control study.
Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
Award date21-Jun-2016
Place of Publication[Groningen]
Print ISBNs978-90-367-8942-4
Electronic ISBNs978-90-367-8941-7
StatePublished - 2016

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