Edward P. K. Parker

Background: Seasonal influenza causes significant global morbidity, particularly among older adults and those with long-term health conditions. We evaluated recent influenza vaccine uptake in England to determine whether the programme effectively reaches individuals at highest risk of severe outcomes. Methods: We conducted a cohort study using anonymised primary care records from English practices contributing to Clinical Practice Research Datalink Aurum (1 September 2019-28 February 2024). We included adults (≥18 years) eligible for influenza vaccination either due to age or long-term health condition. Our primary outcome was influenza vaccination by 28 February. Exposures included multimorbidity and prior hospitalisation. In individuals with diabetes mellitus, we assessed established markers of clinical severity (glycaemic control, diabetes-related complications, and insulin use). For each season, associations were modelled using Poisson generalised linear models. Findings: The number of eligible individuals ranged between 3,492,549 (2019/20) and 5,107,653 (2021/22). Uptake was higher among age-eligible individuals (63·9%-78·2%) compared to those eligible based only on long-term conditions (35·2%-44·1%). Across these eligibility groups, uptake increased with multimorbidity count, was higher among individuals with diabetes using insulin or with diabetes-related complications, and lower for those with poorly controlled glucose levels. The association between prior acute respiratory infection-related hospitalisation and uptake varied by eligibility group. Interpretation: Age-based eligibility improves seasonal influenza vaccine uptake overall and among those at highest risk of severe outcomes. Low uptake in younger adults is partly mitigated by multimorbidity or diabetes-related complications but is suboptimal in those with poor glycaemic control. Expanded age-based eligibility and integration of vaccination into chronic disease management should be considered to enhance uptake. Funding: National Institute for Health and Care Research.

Mpox is a zoonotic disease caused by the monkeypox virus (MPXV) that became a global health concern following the 2022 outbreak. It poses a significant thr

Electronic health records (EHRs) are a rich source of data which can be used to analyse health outcomes using computable phenotypes. With the approval of NHS England we used the OpenSAFELY secure analytics platform to design and assess phenotypes to classify three key respiratory viruses – respiratory syncytial virus (RSV), influenza, and COVID-19 – in English coded health data between September 2016 and August 2024. We compared narrow and broad phenotypes to one another and to publicly available surveillance data. Cases from both phenotypes showed similar seasonal patterns to surveillance data. Broad phenotypes led to increased risk of misclassification than narrow phenotypes for mild cases. For severe cases the risk of misclassification was higher in infants than for older adults, irrespective of the phenotype used. The phenotypes presented here offer a potential route to classify respiratory viruses from coded health records in the absence of testing information.

Background: In England, individuals with chronic liver disease (CLD) are among those with the lowest seasonal influenza vaccine uptake despite being at elevated risk of severe influenza. We examined the relationship between CLD severity and aetiology, and influenza vaccine uptake in England. Methods: A retrospective cohort study of adults (18-115 years) using Clinical Practice Research Datalink Aurum primary care data was conducted for five seasons (2019/20-2023/24). Poisson regression was used to estimate rates of uptake by CLD severity (clinical diagnoses categorised as low, moderate, or severe) and aetiology (alcohol-related, viral-related, and diagnoses in the Green Book guidelines). Findings: There were 182,174-277,470 with CLD per cohort. Among those who were additionally age-eligible for vaccination, uptake was 71.1-79.7% compared to 30.9-40.5% in those not additionally age-eligible. Among individuals below age eligibility without other comorbidities, severity was associated with higher uptake (incidence rate ratio [IRR] moderate 1.80, 95% CI 1.69-1.90; severe 1.95, 95% CI 1.84-2.08 in 2023/24); there was no effect in those with at least one additional comorbidity (moderate 1.05, 95% CI 0.99-1.10; severe 1.05, 95% CI 1.01-1.09). Alcohol- and viral-related aetiology were also associated with increased uptake in those not additionally age-eligible. Among individuals meeting age eligibility without additional comorbidities, severity was associated with a reduced uptake (moderate 0.81, 95% CI 0.73-0.90; severe 0.79, 95% CI 0.74-0.85), with attenuation in those with additional comorbidities (moderate 0.99, 95% CI 0.94-1.04; severe 0.91, 95% CI 0.89-0.94). Interpretation: CLD severity and aetiology were important determinants of uptake in the absence of additional indications for influenza vaccination. Future research should prioritise understanding facilitators and barriers to vaccine uptake in individuals with CLD, particularly for those at highest risk of severe infection. Funding: NIHR Health Protection Research Unit in Vaccines and Immunisation (NIHR200929/NIHR207408).

The global response to COVID-19 saw the most rapid and extensive vaccination rollout in history. Yet there were large disparities in the introduction, scale-up, and evaluation of programmes. To systematically quantify these disparities, we generate linkages across public datasets containing country- and territory-level income data, COVID-19 vaccination rates, and COVID-19 vaccine effectiveness (VE). Our results show that, compared with high-income countries, lower-income countries introduced vaccines later, were less likely to achieve key coverage milestones, and were slower to do so where these milestones were achieved. The literature on primary series COVID-19 VE has been dominated by studies of mRNA vaccines from high-income countries, with data for other vaccines and lower-income countries appearing later and in substantially lower quantities. For vaccines with available VE data across multiple income settings (BNT162b2, mRNA-1273, and ChAdOx1-S), our meta-regression highlights robust protection against severe COVID-19, with no significant differences in primary series VE according to country-level income status during the Delta and Omicron periods. Our findings demonstrate the strong protection conferred by COVID-19 vaccines across diverse populations. Nonetheless, our results quantify the stark disparities that pervaded each stage of COVID-19 vaccine implementation, and highlight evidence gaps related to products and platforms being used across much of the globe.