Relative effectiveness of high dose versus standard dose influenza vaccines in older adult outpatients over four seasons, 2015–16 to 2018–19 |
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| Institution: | 1. University of Pittsburgh, Schools of the Health Sciences and UPMC, Pittsburgh, PA, USA;2. Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Korea University, Ansan Hospital, Seoul, Republic of Korea;3. University of Michigan, Ann Arbor MI and Henry Ford Health System, Detroit, MI, USA;4. Marshfield Clinic Research Institute, Marshfield, WI, USA;5. Baylor Scott and White Health, Texas A&M University Health Science Center, College of Medicine, Temple, TX, USA;6. Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA;7. Centers for Disease Control and Prevention, Influenza Division, National Center for Immunization and Respiratory Diseases, Atlanta, GA, USA;1. Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain;2. CIBER Epidemiología y Salud Pública (CIBERESP), Spain;3. Complejo Hospitalario de Navarra – IdiSNA, Pamplona, Spain;4. Centro Nacional de Microbiología (WHO National Influenza Centre – Madrid), Instituto de Salud Carlos III, Majadahonda, Spain;1. Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland;2. Department of Geography, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland;3. Department of Health Sciences, Helsana Group, Zürichstrasse 130, 8600 Dübendorf, Switzerland;4. Institute of Primary Care, University of Zurich and University Hospital Zurich, Pestalozzistrasse 24, 8091 Zürich, Switzerland;5. Division of Occupational and Environmental Medicine, Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich and University Hospital Zurich, Hirschengraben 84, 8001 Zurich, Switzerland;1. University of Pittsburgh Department of Epidemiology, Suite 600 Schenley Place, 4420 Bayard St., Pittsburgh, PA 15260 USA;2. University of Pittsburgh Department of Family Medicine, Suite 520 Schenley Place, 4420 Bayard St., Pittsburgh, PA 15260 USA;3. UPMC Health System Department of Pharmacy, Division of Infectious Diseases/Pharmacy Department – AMP 5th Floor Falk Medical Building, 3601 Fifth Ave, Pittsburgh, PA, USA;1. Department of Virus and Microbiological Special diagnostics, National Influenza Center, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark;2. Department of Infectious Diseases and Centre for Global Health, Clinical Institute, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark;3. Department of Infectious Disease Epidemiology & Prevention, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark;4. Department of Clinical Microbiology, Herlev Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark;5. Department of Clinical Microbiology, Slagelse Hospital, Ingemannsvej 18, 4200 Slagelse, Denmark;6. Department of Clinical Microbiology, Aalborg University Hospital, Hobrovej 18-22, 9100 Aalborg, Denmark;7. Department of Clinical Microbiology, Vejle Sygehus, Beriderbakken 4, 7100 Vejle, Denmark;8. Department of Clinical Microbiology, Odense University Hospital, Søndre Blvd. 29, 5000 Odense C, Denmark;9. Department of Clinical Microbiology, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Denmark;1. Public Health England, London, UK;2. Public Health England, Bristol, UK;1. Defense Health Agency/Air Force Health Surveillance Branch-Air Force Satellite, United States;2. STS Systems Integration, LLC, San Antonio, TX, United States |
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| Abstract: | BackgroundNew influenza vaccine formulations are designed to improve vaccine effectiveness and protect those most vulnerable to infection. High dose trivalent inactivated influenza vaccine (HD-IIV3), licensed for ages ≥65 years, produces greater antibody responses and efficacy in clinical trials, but post-licensure vaccine effectiveness (VE) compared to standard dose (SD-IIV3/4) vaccine remains an open question.MethodsUsing a test-negative, case control design and propensity analyses to adjust for confounding, US Influenza VE Network data from the 2015–2016 through 2018–2019 seasons were analyzed to determine relative VE (rVE) between HD-IIV3 and SD-IIV3/4 among outpatients ≥65 years old presenting with acute respiratory illness. Influenza vaccination status was derived from electronic medical records and immunization registries.ResultsAmong 3861 enrollees, 2993 (78%) were vaccinated; 1573 (53%) received HD-IIV3 and 1420 (47%) received SD-IIV3/4. HD-IIV3 recipients differed from SD-IIV3/4 recipients by race, previous vaccination, number of outpatient visits in the previous year and timing of vaccination, and were balanced in the propensity model except the timing of vaccination. Compared with no vaccination, significant protection against any influenza A was observed from both HD-IIV3 (VE = 29%; 95%CI = 10%, 44%) and SD-IIV3/4 (VE = 24%; 95%CI = 5%, 39%); rVE = 18% (95%CI = 0%, 33%, SD as referent). When stratified by virus type, against A/H1N1, HD-IIV3 VE was 30% (95%CI = ?7%, 54%), SD-IIV3/4 VE was 40% (95%CI = 10%, 61%), and rVE = ?32%; (95%CI = ?94%, 11%); Against A/H3N2, HD-IIV3 VE was 31% (95%CI = 9%, 47%), SD-IIV3/4 VE was 19% (95%CI = ?5%, 37%), and rVE = 27%; (95% CI = 9%, 42%).ConclusionsAmong adults ≥65 years of age, recipients of standard and high dose influenza vaccines differed significantly in their characteristics. After adjusting for these differences, high dose vaccine offered more protection against A/H3N2 and borderline significant protection against all influenza A requiring outpatient care during the 2015–2018 influenza seasons. |
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| Keywords: | High dose influenza vaccine Standard dose influenza vaccine Older adults Vaccine effectiveness |
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