Evaluation of the Effectiveness of Pandemic Influenza A(H1N1) 2009 Vaccine Based on an Outbreak Investigation During the 2010–2011 Season in Korean Military Camps

OBJECTIVES In December 2010, there was an outbreak of acute febrile respiratory disease in many Korean military camps that were not geographically related. A laboratory analysis confirmed a number of these cases to be infected by the pandemic influenza A(H1N1) 2009 (H1N1pdm09) virus. Because mass vaccination against H1N1pdm09 was implemented at the infected military camps eleven months ago, the outbreak areas in which both vaccinated and nonvaccinated individuals were well mixed, gave us an opportunity to evaluate the effectiveness of H1N1pdm09 vaccine through a retrospective cohort study design. METHODS A self-administered questionnaire was distributed to the three military camps in which the outbreak occurred for case detection, determination of vaccination status, and characterization of other risk factors. The overall response rate was 86.8% (395/455). Case was defined as fever (≥38 °C) with cough or sore throat, influenza-like illness (ILI), and vaccination status verified by vaccination registry. Crude vaccine effectiveness (VE) was calculated as "1 - attack rate in vaccinated individuals/attack rate in nonvaccinated individuals", and adjusted VE was calculated as "1 - odds ratio" using logistic regression adjusted for potential confounding factor. A number of ILI definitions were used to test the robustness of the result. RESULTS The attack rate of ILI was 12.8% in register-verified vaccinated individuals and 24.0% in nonvaccinated individuals. The crude VE was thus calculated to be 46.8% [95% confidence interval (CI): 14.5-66.9]. The adjusted VE rate was 46.8% (95% CI: -9.4 to 74.1). Various combinations of ILI symptoms also showed similar VE rates. CONCLUSION We evaluated the effectiveness of H1N1pdm09 vaccine in the 2010-2011 season in an outbreak setting. Although the result was not sensitive to any analytical method used and ILI case definition, the magnitude of effectiveness was lower than estimated in the 2009-2010 season.