ArticleEpidemiology and infection2019
Depletion-of-susceptibles bias in influenza vaccine waning studies: how to ensure robust results.
Article in Epidemiology and infection, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
38 citing papers in PubMed.
- A simple and powerful test of vaccine waning.American journal of epidemiology · 2026Article
- Respiratory Syncytial Virus-Related Hospitalizations Among Infants Receiving Nirsevimab.JAMA network open · 2026Article
- Utilizing virus genomic surveillance to predict vaccine effectiveness.PLoS computational biology · 2026Article
- Article
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- Effectiveness of the 2024-2025 KP.2 COVID-19 vaccines in the United States during long-term follow-up.Nature communications · 2025Article
- Monitoring effectiveness of nirsevimab immunization against RSV hospitalization using surveillance data: a test-negative case-control study, Spain, October 2024-March 2025.Epidemiology and infection · 2025Article
- Waning in influenza vaccine effectiveness against influenza A(H1N1)pdm09-associated hospitalization in children in 2012/2013.Epidemiology and infection · 2025Article
- Estimating Influenza Vaccine Effectiveness Against Laboratory-Confirmed Influenza Using Linked Public Health Information Systems, California, 2023-2024 Season.The Journal of infectious diseases · 2025Article
- Vaccine failure mode determines population-level impact of vaccination campaigns during epidemics.Journal of the Royal Society, Interface · 2025Article
- Article
- Effectiveness over time of a primary series of the original monovalent COVID-19 vaccines in adults in the United States.PloS one · 2025Article
- Estimated Effectiveness of Influenza Vaccines in Preventing Secondary Infections in Households.JAMA network open · 2024Article
- Vaccination against rapidly evolving pathogens and the entanglements of memory.Nature immunology · 2024Review
- Evaluating the impact of extended dosing intervals on mRNA COVID-19 vaccine effectiveness in adolescents.BMC medicine · 2024Article
- Article
- The impact of underreported infections on vaccine effectiveness estimates derived from retrospective cohort studies.International journal of epidemiology · 2024Article
- Effectiveness of BNT162b2 BA.4/5 Bivalent mRNA Vaccine Against Symptomatic COVID-19 Among Immunocompetent Individuals Testing at a Large US Retail Pharmacy.The Journal of infectious diseases · 2024Article
- Risk of SARS-CoV-2 reinfection during multiple Omicron variant waves in the UK general population.Nature communications · 2024Article
- Measuring waning protection from seasonal influenza vaccination during nine influenza seasons, Ontario, Canada, 2010/11 to 2018/19.Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin · 2024Article
Corrections and comments
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4 authors.
Funding
Abstract
Vaccine effectiveness studies are subject to biases due to depletion-of-persons at risk of infection, or at especially high risk of infection, at different rates from different groups (depletion-of-susceptibles bias), a problem that can also lead to biased estimates of waning effectiveness, including spurious inference of waning when none exists. An alternative study design to identify waning is to study only vaccinated persons, and compare for each day the incidence in persons with earlier or later dates of vaccination to assess waning in vaccine protection as a function of vaccination time (namely whether earlier vaccination would result in lower subsequent protection compared to later vaccination). Prior studies suggested under what conditions this alternative would yield correct estimates of waning. Here we define the depletion-of-susceptibles process formally and show mathematically that for influenza vaccine waning studies, a randomised trial or corresponding observational study that compares incidence at a specific calendar time among individuals vaccinated at different times before the influenza season begins will not be vulnerable to depletion-of-susceptibles bias in its inference of waning as a function of vaccination time under the null hypothesis that none exists, and will - if waning does actually occur - underestimate the extent of waning. Such a design is thus robust in the sense that a finding of waning in that inference framework reflects actual waning of vaccine-induced immunity. We recommend such a design for future studies of waning, whether observational or randomised.
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