On 2023-10-23 04:42:47, user CDSL JHSPH wrote:
Dear Dr. Bi et al,
This is a valuable paper that examines the potential influence of prior-season vaccination on the risk of clinical influenza infection. You recognized that past research has shown that prior-season influenza vaccination is associated with an increased risk of clinical influenza infection among vaccine recipients. A key limitation of these previous studies is their reliance on a test-negative design, which fails to consider the intra-season timing of vaccination and the individual's history of clinical infection in the preceding season.
A noteworthy finding in this paper is that individuals who receive repeat vaccinations tend to get their vaccines earlier in the season compared to non-repeat vaccinees. Remarkably, even when after adjusting for this discrepancy in timing, it does not significantly alter the observed higher probability of clinical infection in repeat vaccinees.
Clinical infection seems to play a dual role in influencing vaccination behavior. First, it serves as a motivator, prompting individuals to get vaccinated in the following season. Second, it also provides some degree of protection against clinical infection of the same subtype. However, even after accounting for recent clinical infections, the effect of prior-season vaccination on the current season's clinical infection risk remains not significantly different.
A potential mitigating factor, subclinical infection, is theoretically posited to attenuate the effect of prior-season vaccination. However, you were clear in the paper that this aspect is still largely theoretical and necessitates further investigation to determine its actual impact on vaccine efficacy.
The primary contribution of this pre-print lies in its careful consideration of confounding factors, specifically the intra-season timing of vaccination and the history of clinical infection in the previous season. By addressing these variables, it challenges the established findings of prior research, which suggest an elevated risk of clinical influenza infection associated with prior-season vaccination. These insights carry significant public health implications, particularly in the realm of vaccine policy and compliance.
The paper is methodologically robust, particularly in the sections that explore the impact of timing and previous clinical infection. However, the discussion of subclinical infection is less conclusive, as it relies on a theoretical model and a pseudo-population. The exact details are not in the main body of the paper and was referred to the supplemental section. As the explanation for the main findings of the paper is hinged on subclinical infection, it may be helpful to develop this idea further in the main text.
In terms of its presentation, the paper is well-structured with clear delineation of sections, and the text is appropriately complemented by the figures. The inclusion of the "infection block hypothesis" in the discussion aids in facilitating a deeper understanding of the research.
Overall, this paper marks a significant breakthrough by challenging the conventional approach to assessing vaccine efficacy, incorporating the roles of vaccination timing and previous clinical infection. It also highlights the potential importance of subclinical infections, opening important conversations and may lead to enhanced strategies for data collection in this context.
We truly appreciate you sharing your pre-print with us.