Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2026
Assessment of timing for influenza vaccination among older adults in Japan: the Vaccine Effectiveness, Networking, and Universal Safety (VENUS) study.
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Mimura Wataru, Ishiguro Chieko, Shimizu Yosuke, Terada-Hirashima Junko, Maeda Megumi, Oda Futoshi, Fukuda Haruhisa
Аннотация
OBJECTIVES: In Japan, seasonal influenza vaccination is recommended for older adults between October and mid-December; however, the optimal vaccination timing remains unclear owing to waning immunity and variable epidemic patterns. In this study, we aimed to assess the effectiveness of different vaccination strategies in reducing influenza-related outcomes in older adults.
METHODS: Using data from the vaccine effectiveness, networking, and universal safety study, we conducted a target trial emulation including adults aged ≥65 years across four influenza seasons (2016/2017, 2017/2018, 2018/2019, and 2019/2020). We applied a cloning, censoring, and weighting approach. Each individual was cloned and assigned to one of seven vaccination strategies at the start of October: no vaccination, vaccination during October, October-November, October-December, November, November-December, or December. Outcomes included influenza, influenza-related hospitalization, and all-cause mortality. Risk ratios (RRs) and risk differences, relative to no vaccination, were estimated at the end of March for each season based on standardized cumulative incidence.
RESULTS: Annual cohorts included 131 178-138 438 individuals (meanage: 76-77 years; male sex: 40.7-41.0%). The influenza incidences and RRs varied by season. Delayed vaccination was associated with the lowest influenza incidence in the 2017/2018 and 2018/2019, but not in the other seasons. Influenza-related hospitalizations showed seasonal trends similar to those of influenza. In contrast, early vaccination strategies generally led to reduced all-cause mortality across all seasons. The RRs were 0.80-0.93, 0.80-0.95, 0.82-1.00, and 0.81-0.96 in the 2016/2017, 2017/2018, 2018/2019, and 2019/2020 seasons, respectively. The risk differences were larger for mortality than for the influenza-related outcomes.
CONCLUSIONS: The effectiveness of each timing strategy varied depending on the outcome and season. Although delayed vaccination was associated with a lower influenza incidence in some seasons, early vaccination generally reduced all-cause mortality.
METHODS: Using data from the vaccine effectiveness, networking, and universal safety study, we conducted a target trial emulation including adults aged ≥65 years across four influenza seasons (2016/2017, 2017/2018, 2018/2019, and 2019/2020). We applied a cloning, censoring, and weighting approach. Each individual was cloned and assigned to one of seven vaccination strategies at the start of October: no vaccination, vaccination during October, October-November, October-December, November, November-December, or December. Outcomes included influenza, influenza-related hospitalization, and all-cause mortality. Risk ratios (RRs) and risk differences, relative to no vaccination, were estimated at the end of March for each season based on standardized cumulative incidence.
RESULTS: Annual cohorts included 131 178-138 438 individuals (meanage: 76-77 years; male sex: 40.7-41.0%). The influenza incidences and RRs varied by season. Delayed vaccination was associated with the lowest influenza incidence in the 2017/2018 and 2018/2019, but not in the other seasons. Influenza-related hospitalizations showed seasonal trends similar to those of influenza. In contrast, early vaccination strategies generally led to reduced all-cause mortality across all seasons. The RRs were 0.80-0.93, 0.80-0.95, 0.82-1.00, and 0.81-0.96 in the 2016/2017, 2017/2018, 2018/2019, and 2019/2020 seasons, respectively. The risk differences were larger for mortality than for the influenza-related outcomes.
CONCLUSIONS: The effectiveness of each timing strategy varied depending on the outcome and season. Although delayed vaccination was associated with a lower influenza incidence in some seasons, early vaccination generally reduced all-cause mortality.