We hypothesised that the widespread use of influenza POCT in primary care may also contribute to real world evidence on IVE. Patients with a positive influenza POCT test were significantly less likely to be prescribed an antibiotic and significantly more likely to be prescribed antiviral medication (odds ratios of 0.4, 95%CI: 0.19–0.78 and 14.1, 95%CI: 2.85–70.0 respectively) compared to those with a negative influenza POCT result. POCT machines also influenced clinical prescribing practices. Study practices provided POCT machines performed more tests than other virology sampling practices when their practice population size and respiratory virus infection rates were taken into account. We have previously shown testing for influenza using rapid molecular POCT machines is feasible in primary care and associated with improvements in appropriate antiviral and antibiotic use. This has allowed rapid, accurate pathological confirmation of influenza infection in the community, and is crucial to undertaking IVE studies in primary care. These highly accurate tests use nucleic acid amplification tests such as reverse transcription polymerase chain reaction (RT-PCR) which had previously been reserved for use in centralised laboratories. In the last few years rapid molecular point of care test (POCT) platforms for influenza have become widely available in primary care. This includes studies in real world settings such as primary care to provide specific IVE data including product (brand) specific IVE studies as part of their post-licensure requirements, rather than only relying on annual clinical immunogenicity trials of vaccine. Regulatory agencies such as the European Medicines Agency (EMA) now require vaccine manufacturers to undertake studies in different settings. IVE thus varies depending on whether it is measured in secondary or primary care settings. IVE is interpreted as the proportionate reduction in disease among the vaccinated group in real world conditions as opposed to efficacy in ideal conditions, such as a clinical trial. Thus influenza vaccine effectiveness (IVE) is assessed annually and observed IVE varies year-to-year. The vaccine requires reformulating annually to match with the characteristics of the circulating influenza viruses which undergo frequent genetic and antigenic changes. A population vaccination coverage target of at least 75% in the elderly population and among risk groups is recommended by the World Health Organization (WHO). Vaccination is considered as the most effective means for preventing influenza and its complications. Complications are more common in older and younger age groups, over 65 years and under one year respectively. It is estimated to account for 11.5% of all episodes of respiratory infection in the UK, with over 50 000 patients requiring hospital admission and at least 2000 deaths per year. Influenza is a major cause of clinical and public health burden.
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