Using validation sets for outcomes and exposure to infection in vaccine field studies

Methods of adjusting for bias in estimates due to mismeasured or missing covariates and outcomes through the use of validation sets have been developed in many types of health studies. These methods can be employed for the efficient design and analysis of vaccine studies as well. On the one hand, nonspecific case definitions can lead to attenuated efficacy and effectiveness estimates, but confirmation by culture or a quick test of the infectious agent is also expensive and difficult. On the other hand, data on exposure to infection can influence estimates of vaccine efficacy, but good data on exposure are difficult to obtain. In this paper, the authors show how use of small validation sets can correct the bias of the estimates obtained from a large main study while maintaining efficiency. They illustrate the approach for outcomes using the example of influenza vaccine efficacy and effectiveness trials and illustrate the approach for exposure to infection using the example of a human immunodeficiency virus vaccine trial. The authors discuss challenges posed by infectious diseases in the use of currently available methods. Development of these efficient designs and methods of analysis for vaccine field studies will improve estimation of vaccine efficacy for both susceptibility and infectiousness, as well as estimation of indirect and overall effects of vaccination in community trials.