Influenza Vaccine Effectiveness Against Influenza A(H3N2)-Related Illness in the United States During the 2021-2022 Influenza Season

Clin Infect Dis. 2023 Apr 17;76(8):1358-1363. doi: 10.1093/cid/ciac941.


Background: In the United States, influenza activity during the 2021-2022 season was modest and sufficient enough to estimate influenza vaccine effectiveness (VE) for the first time since the beginning of the coronavirus disease 2019 pandemic. We estimated influenza VE against laboratory-confirmed outpatient acute illness caused by predominant A(H3N2) viruses.

Methods: Between October 2021 and April 2022, research staff across 7 sites enrolled patients aged ≥6 months seeking outpatient care for acute respiratory illness with cough. Using a test-negative design, we assessed VE against influenza A(H3N2). Due to strong correlation between influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination, participants who tested positive for SARS-CoV-2 were excluded from VE estimations. Estimates were adjusted for site, age, month of illness, race/ethnicity, and general health status.

Results: Among 6260 participants, 468 (7%) tested positive for influenza only, including 440 (94%) for A(H3N2). All 206 sequenced A(H3N2) viruses were characterized as belonging to genetic group 3C.2a1b subclade 2a.2, which has antigenic differences from the 2021-2022 season A(H3N2) vaccine component that belongs to clade 3C.2a1b subclade 2a.1. After excluding 1948 SARS-CoV-2-positive patients, 4312 patients were included in analyses of influenza VE; 2463 (57%) were vaccinated against influenza. Effectiveness against A(H3N2) for all ages was 36% (95% confidence interval, 20%-49%) overall.

Conclusions: Influenza vaccination in 2021-2022 provided protection against influenza A(H3N2)-related outpatient visits among young persons.

Keywords: case control; influenza; test-negative; vaccination.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • COVID-19* / epidemiology
  • COVID-19* / prevention & control
  • Humans
  • Influenza A Virus, H3N2 Subtype
  • Influenza B virus
  • Influenza Vaccines*
  • Influenza, Human* / epidemiology
  • Influenza, Human* / prevention & control
  • SARS-CoV-2
  • Seasons
  • United States / epidemiology
  • Vaccination
  • Vaccine Efficacy


  • Influenza Vaccines