title: Effectiveness and knowledge, attitudes and practices of seasonal influenza vaccine in primary healthcare settings in South Africa, 2010-2013.
abstract: OBJECTIVE
  Influenza vaccine effectiveness (VE) and coverage data for sub-Saharan Africa are scarce. Using a test-negative case-control design, we estimated influenza VE annually among individuals with influenza-like illness presenting to an outpatient sentinel surveillance programme in South Africa from 2010 to 2013. A knowledge, attitudes and practices (KAP) influenza vaccine survey of programme clinicians was conducted in 2013.
  
  
  METHODS
  In total, 9420 patients were enrolled in surveillance of whom 5344 (56.7%) were included in the VE analysis: 2678 (50.1%) were classified as controls (influenza test-negative) and 2666 (49.9%) as cases (influenza test-positive).
  
  
  RESULTS
  Mean annual influenza vaccine coverage among controls was 4.5% for the four years. Annual VE estimates adjusted for age, underlying medical conditions and seasonality for 2010-2013 were 54.2% (95% confidence interval (CI): 2.4-78.6%), 57.1% (95% CI: 15.5-78.2%), 38.4% (95% CI: -71.7-78.1%) and 87.2% (95% CI: 67.2-95.0%), respectively. The KAP survey showed that >90% of clinicians were familiar with the indications for and the benefits of influenza vaccination.
  
  
  CONCLUSIONS
  Our study showed that the vaccine was significantly protective in 2010, 2011 and 2013, but not in 2012 when the circulating A(H3N2) strain showed genetic drift. Vaccine coverage was low despite good clinician knowledge of vaccination indications. Further studies are needed to investigate the reason for the low uptake of influenza vaccine.
authors: National Institute for Communicable Diseases (NICD) of the National Health Laboratory Services (NHLS), Johannesburg, South Africa.
authors: Johanna M
authors: JM
authors: McAnerney
authors: Sibongile
authors: S
authors: Walaza
authors: Adam L
authors: AL
authors: Cohen
authors: Stefano
authors: S
authors: Tempia
authors: Amelia
authors: A
authors: Buys
authors: Marietjie
authors: M
authors: Venter
authors: Lucille
authors: L
authors: Blumberg
authors: Jazmin
authors: J
authors: Duque
authors: Cheryl
authors: C
authors: Cohen
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D040961:Genetic Drift; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D053118:Influenza A Virus, H1N1 Subtype / Q000276:immunology; D053122:Influenza A Virus, H3N2 Subtype / Q000276:immunology; D009981:Influenza B virus / Q000276:immunology; D007252:Influenza Vaccines; D007251:Influenza, Human / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data; D012621:Seasons; D018571:Sentinel Surveillance; D013019:South Africa / Q000453:epidemiology; D013997:Time Factors; D014611:Vaccination / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D007252:Influenza Vaccines
keywords: Influenza-like illness; attitudes; knowledge; practices; vaccine