Spotlight On: Influenza Research

Influenza viruses cause sickness and death around the world, with annual global fatalities estimated to be between 291,000 and 646,000, according to the Centers for Disease Control and Prevention (CDC). For over a decade, Abt Global has worked to understand the impact and prevent the spread of the disease in the United States and abroad, including in low- and middle-income countries. We have collaborated with CDC on studies of the effectiveness of seasonal and pandemic flu vaccines to prevent death and serious illnesses among high-risk populations. These studies have involved healthcare personnel (HCP), pregnant women, older adults and children.

In addition, we conduct web panel surveys to assess flu vaccine uptake as well as knowledge, attitudes, behaviors and barriers (KABBs) concerning flu and flu vaccine. Using results from these studies and surveys, our experts have co-authored publications with CDC and other clinical partners to inform HCP vaccination recommendations and expand patient use of vaccines.

Approaches

Abt has a range of capabilities related to influenza research and surveillance. We have expertise in clinical research study coordination and pandemic preparedness. We also have experience with the surveillance and monitoring of vaccination coverage and with the development of cutting-edge methodologies to examine vaccine-related data. Our approaches include:

• Coordination of multi-site research studies and networks.
• Clinical study site selection.
• Protocol and standard operating procedure (SOP) development.
• Data management system development.
• Clinical specimen coordination, including coordinating sample storage and shipment.
• Creating analysis-ready datasets.
• Data analysis.
• Dissemination of study findings, including co-authoring manuscripts with CDC and principal investigators and presentations for prominent subject-specific conferences.
• Survey development and adaptation for emerging infections.
• Web panel survey implementation.
• Cognitive computing and natural language processing methodologies.

Relevant Expertise
Clinical Study Coordination

Pregnancy Influenza Vaccine Effectiveness Network
Client: Centers for Disease Control and Prevention

Abt worked with CDC on a multi-country collaboration to investigate the preventive value of flu vaccine among pregnant women, a priority population for CDC. This study employed epidemiologic study designs to address priority questions for this high-risk population through partnerships in the U.S., Canada, Australia and Israel. Results have shown that influenza vaccines offer protection against laboratory-confirmed, flu-related hospitalizations during pregnancy.

Influenza and Respiratory Syncytial Virus (RSV) in Infants Study
Client: Centers for Disease Control and Prevention

This multi-country prospective study of infants in their first year of life assessed the frequency of influenza virus and RSV infections associated with hospitalizations. It also described clinical features and antibody responses to infection and examined predictors of very severe diseases requiring intensive care. We enrolled approximately 3,000 hospitalized infants and 1,400 healthy infants in four countries (Albania, Jordan, Nicaragua, and the Philippines). We collected respiratory specimens from both groups. Data analyses are continuing with multiple peer-reviewed publications planned.

The China Ageing Respiratory infections Study (CARES), a prospective cohort study in older adults in Eastern China
Client: Centers for Disease Control and Prevention

This observational study explored how flu affects adults aged 60 years and older. Abt established a group of participants in two cities in Jiangsu Province, China, to provide direct evidence on the incidence of laboratory-confirmed influenza virus and RSV infections in older adults. We enrolled 1,532 adults between the ages of 60 and 89. We collected blood samples and used face-to-face interviews and a standardized questionnaire to collect baseline data on demographics, general health, chronic diseases, functional status, cognitive function and knowledge, attitudes and practices. Participants were followed weekly throughout the year to identify acute respiratory illnesses. We scheduled home visits to ill participants to collect swabs for laboratory testing and to gather detailed symptom information about the acute illness. Follow-ups took place regularly—including face-to-face interviews every 6 months and further blood draws every 12 months. The data collected in this study will allow CDC to examine the impact of flu and RSV infections on frailty in—and the functional status of—older adults and could help countries determine the value of vaccines as a prevention strategy.

Effectiveness of Influenza Vaccine in Preventing Influenza Virus Infection, Missed Work, and Patient Exposure: A Prospective Cohort Study of Healthcare Personnel (HCP)
Client: Centers for Disease Control and Prevention

This study of healthcare personnel in two middle-income countries (Peru and Israel estimated the effectiveness of flu vaccine in preventing flu, missed work due to flu and missed hours of direct patient care provided by HCP with flu symptoms. Abt investigated the association between repeated flu vaccination and HCP’s baseline immune landscape, HCP’s responses to flu vaccines and subsequent protection against infection. We examined if the vaccine affects symptom severity and duration for HCP who get the flu despite vaccination. Data analyses are ongoing, with multiple peer-reviewed publications planned.

Pandemic Preparedness

The Epidemiology of Novel Influenza Virus Infection and Evaluation of Antiviral and Vaccine Effectiveness
Client: Centers for Disease Control and Prevention

In 2013, CDC awarded Abt a five-year contract to establish a research infrastructure for conducting epidemiologic studies of novel influenza virus and respiratory infections and for evaluating antiviral and vaccine effectiveness. Abt formed partnerships with 17 clinical health organizations to establish this research infrastructure in multiple geographic settings and populations across the U.S. We divided the proposed research into major study populations—including inpatient, ambulatory and among pregnant women and infants—and settings, including community settings. Abt led the development of standardized protocols and selected sites in conjunction with CDC for each study population. In 2018 and 2019, CDC awarded Abt two follow-on contracts to extend readiness. Early in the COVID-19 pandemic in 2020, CDC and Abt leveraged this infrastructure to begin studies and data collection on this novel respiratory virus without delay. 

Pandemic Preparedness Workshop Development for Regional Offices of the World Health Organization (WHO)
Client: Centers for Disease Control and Prevention

Abt partnered with CDC and WHO to develop materials for regional pandemic preparedness workshops for country representatives. The WHO regional offices in Africa and the Eastern Mediterranean collaborated with Abt during the development process and served as the regional offices for a pilot training. We developed a situational analysis tool that covers topics including preparing for an emergency, surveillance/reporting during a pandemic, health services and clinical management. Abt and WHO staff conducted training on the tool at a pilot workshop and integrated feedback for the final product. The project provided important support for regions that will enable them to build action plans and infrastructure in preparation for a potential pandemic flu outbreak.

Vaccination Coverage Surveillance

Surveys to Monitor Vaccinations Among Health Care Personnel and Pregnant Women
Client: Centers for Disease Control and Prevention

Abt determined vaccination coverage among health care personnel and pregnant women by developing and implementing online surveys during each flu season from 2014-2023. The surveys have asked about flu, Tdap, and COVID-19 vaccines and each season Abt delivered coverage estimates to CDC. This rapid data collection provides needed information on vaccination coverage among high-risk populations and actual and perceived barriers to vaccination in advance of the forthcoming season. With our nimble survey platform, we quickly developed and added survey questions related to the Zika virus in 2016 and 2017 and to COVID-19 starting in 2020, demonstrating our ability to integrate new survey questions rapidly in response to emerging infections. Such fast turnarounds can increase the efficiency and effectiveness of communications campaigns aimed at health care personnel and pregnant women. Abt is conducting surveys again in spring 2024. 

Cognitive Computing

Pilot to Assess Cognitive Computing to Analyze Immunization Program Data
Client: Centers for Disease Control and Prevention

Abt partnered with CDC to explore new ways to process vaccination-related data from diverse data sources through a joint pilot with Temple University. The pilot developed a vaccination-specific, language-based platform—or lexicon—for custom analytics of unstructured text. The lexicon was well developed and epidemiology-specific (to separate shingles as a virus from shingles used for roofing). It is unique in that it is designed to work with formal (e.g., state or federal vaccine guidelines) and/or informal (e.g., social media) data. In addition, we explored multiple processing algorithms for lexicon creation and assessed data quality by looking at the volume of vaccination-related discussion on Twitter as well as exploring algorithms for bot-detection.