{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:50:02Z","timestamp":1792788602436,"version":"4.5.0"},"reference-count":45,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,6,11]],"date-time":"2025-06-11T00:00:00Z","timestamp":1749600000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Health and Medical Research Fund, Health Bureau"},{"name":"Government of the Hong Kong Special Administrative Region"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,6,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In test-negative design (TND) studies that use rapid tests to estimate influenza vaccine effectiveness (VE), a common concern is case\u2013control misclassification due to imperfect diagnostic accuracy. An imperfect test can also fail to exclude from the control group people infected with other influenza types or other vaccine-preventable respiratory viruses. We investigated these biases while evaluating VE for the 2023\/24 seasonal influenza vaccination.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A TND study was conducted among outpatients aged \u22656\u2009months of age who visited an outpatient clinic in Hong Kong between 15 December 2023 and 13 August 2024. VE was estimated for polymerase chain reaction (PCR)- and rapid-test-confirmed influenza A and B with exclusions of other types of influenza and SARS-CoV-2 based on either PCR or rapid test. Alternatively, for the exclusion of SARS-CoV-2, we adjusted the analysis with COVID-19 vaccination. VE was estimated by using logistic regression adjusted for confounders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In a study population of 1691 participants, VE against influenza A by PCR was 49% [95% confidence interval (CI) 26%\u201365%] after the exclusion of PCR-confirmed influenza B and SARS-CoV-2 controls. The corresponding VE against influenza B was 65% (95% CI 35%\u201381%). VE estimated by adjusting for COVID-19 vaccination status yielded similar estimates to these. When case\u2013control status and exclusions from test-negative controls were determined by using the rapid test, VE was reduced by 5%age\u201315%age points.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In TND studies using rapid tests, reduced sensitivity affects both case\u2013control classification and control group exclusions, potentially causing bias. New methods for these biases could help to adapt participatory cohorts for the monitoring of VE for influenza, COVID-19, and respiratory syncytial virus.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ije\/dyaf089","type":"journal-article","created":{"date-parts":[[2025,5,24]],"date-time":"2025-05-24T07:19:59Z","timestamp":1748071199000},"source":"Crossref","is-referenced-by-count":1,"title":["Bias in control selection associated with the use of rapid tests in influenza vaccine effectiveness studies"],"prefix":"10.1093","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5776-5897","authenticated-orcid":false,"given":"Eero","family":"Poukka","sequence":"first","affiliation":[{"name":"Department of Public Health, Finnish Institute for Health and Welfare (THL) , Helsinki,","place":["Finland"]},{"name":"Department of Public Health, Faculty of Medicine, University of Helsinki , Helsinki,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitriona","family":"Murphy","sequence":"additional","affiliation":[{"name":"World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Pokfulam, Hong Kong Special Administrative Region,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loretta","family":"Mak","sequence":"additional","affiliation":[{"name":"World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Pokfulam, Hong Kong Special Administrative Region,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel M S","family":"Cheng","sequence":"additional","affiliation":[{"name":"World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Pokfulam, Hong Kong Special Administrative Region,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malik","family":"Peiris","sequence":"additional","affiliation":[{"name":"World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Pokfulam, Hong Kong Special Administrative Region,","place":["China"]},{"name":"Centre for Immunology and Infection, Hong Kong Science and Technology Park , Hong Kong Special Administrative Region,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim K","family":"Tsang","sequence":"additional","affiliation":[{"name":"World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Pokfulam, Hong Kong Special Administrative Region,","place":["China"]},{"name":"Laboratory of Data Discovery for Health Limited, Hong Kong Science and Technology Park , Hong Kong Special Administrative Region,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheena G","family":"Sullivan","sequence":"additional","affiliation":[{"name":"School of Clinical Sciences, Monash University , Melbourne, Victoria,","place":["Australia"]},{"name":"Department of Epidemiology, University of California , Los Angeles, California,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin J","family":"Cowling","sequence":"additional","affiliation":[{"name":"World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Pokfulam, Hong Kong Special Administrative Region,","place":["China"]},{"name":"Laboratory of Data Discovery for Health Limited, Hong Kong Science and Technology Park , Hong Kong Special Administrative Region,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,6,26]]},"reference":[{"key":"2025062701380451900_dyaf089-B1","doi-asserted-by":"crossref","first-page":"6117","DOI":"10.1016\/j.vaccine.2018.08.075","article-title":"The effectiveness of influenza vaccination against medically-attended illnesses in Hong Kong across three years with different degrees of vaccine match, 2014\u201317","volume":"36","author":"Tam","year":"2018","journal-title":"Vaccine"},{"key":"2025062701380451900_dyaf089-B2","doi-asserted-by":"crossref","first-page":"4842","DOI":"10.1016\/j.vaccine.2021.07.014","article-title":"Influenza vaccine effectiveness against influenza-associated hospitalization in children in Hong Kong, 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