title: Seasonal Influenza Vaccine Effectiveness in the community (SIVE): protocol for a cohort study exploiting a unique national linked data set.
abstract: BACKGROUND
  Seasonal influenza vaccination is recommended for all individuals aged 65 years and over and in individuals younger than 65 years with comorbidities. There is good evidence of vaccine effectiveness (VE) in young healthy individuals but less robust evidence for effectiveness in the populations targeted for influenza vaccination. Undertaking a randomised controlled trial to assess VE is now impractical due to the presence of national vaccination programmes. Quasi-experimental designs offer the potential to advance the evidence base in such scenarios, and the authors have therefore been commissioned to undertake a naturalistic national evaluation of seasonal influenza VE by using data derived from linkage of a number of Scottish health databases. The aim of this study is to examine the effectiveness of the seasonal influenza vaccination in the Scottish population.
  
  
  METHODS
  A cohort study design will be used pooling data over nine seasons. A primary care database covering 4% of the Scottish population for the period 2000-2009 has been linked to the national database of hospital admissions and the death register and is being linked to the Health Protection Scotland virology database. The primary outcome is VE measured in terms of rate of hospital admissions due to respiratory illness. Multivariable regression will be used to produce estimates of VE adjusted for confounders. The major challenge of this approach is addressing the strong effect of confounding due to vaccinated individuals being systematically different from unvaccinated individuals. Analyses using propensity scores and instrumental variables will be undertaken, and the effect of an unknown confounder will be modelled in a sensitivity analysis to assess the robustness of the estimates.
  
  
  BACKGROUND
  The West of Scotland Research Ethics Committee has classified this project as surveillance. The study findings will be disseminated in peer-reviewed publications and presented at international conferences.
authors.affiliation: Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK.
authors.forename: Nazir I
authors.initials: NI
authors.lastname: Lone
authors.forename: Colin
authors.initials: C
authors.lastname: Simpson
authors.forename: Kimberley
authors.initials: K
authors.lastname: Kavanagh
authors.forename: Chris
authors.initials: C
authors.lastname: Robertson
authors.forename: Jim
authors.initials: J
authors.lastname: McMenamin
authors.forename: Lewis
authors.initials: L
authors.lastname: Ritchie
authors.forename: Aziz
authors.initials: A
authors.lastname: Sheikh