1
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Chaves SS, Naeger S, Lounaci K, Zuo Y, Loiacono MM, Pilard Q, Nealon J, Genin M, Mahe C. High-Dose Influenza Vaccine Is Associated With Reduced Mortality Among Older Adults With Breakthrough Influenza Even When There Is Poor Vaccine-Strain Match. Clin Infect Dis 2023; 77:1032-1042. [PMID: 37247308 PMCID: PMC10552589 DOI: 10.1093/cid/ciad322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 05/09/2023] [Accepted: 05/24/2023] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND High-dose (HD) influenza vaccine offers improved protection from influenza virus infection among older adults compared with standard-dose (SD) vaccine. Here, we explored whether HD vaccine attenuates disease severity among older adults with breakthrough influenza. METHODS This was a retrospective cohort study of US claims data for influenza seasons 2016-2017, 2017-2018, and 2018-2019, defined as 1 October through 30 April, among adults aged ≥65 years. After adjusting the different cohorts for the probability of vaccination conditional on patients' characteristics, we compared 30-day mortality rate post-influenza among older adults who experienced breakthrough infection after receipt of HD or SD influenza vaccines and among those not vaccinated (NV). RESULTS We evaluated 44 456 influenza cases: 23 109 (52%) were unvaccinated, 15 037 (33.8%) received HD vaccine, and 6310 (14.2%) received SD vaccine. Significant reductions in mortality rates among breakthrough cases were observed across all 3 seasons for HD vs NV, ranging from 17% to 29% reductions. A significant mortality reduction of 25% was associated with SD vaccination vs NV in the 2016-2017 season when there was a good match between circulating influenza viruses and selected vaccine strains. When comparing HD vs SD cohorts, mortality reductions were higher among those who received HD in the last 2 seasons when mismatch between vaccine strains and circulating H3N2 viruses was documented, albeit not significant. CONCLUSIONS HD vaccination was associated with lower post-influenza mortality among older adults with breakthrough influenza, even during seasons when antigenically drifted H3N2 circulated. Improved understanding of the impact of different vaccines on attenuating disease severity is warranted when assessing vaccine policy recommendations.
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Affiliation(s)
- Sandra S Chaves
- Modelling, Epidemiology and Data Science, Sanofi Vaccines, Lyon, France
| | - Sarah Naeger
- Modelling, Epidemiology and Data Science, Sanofi Vaccines, Lyon, France
| | | | - Yue Zuo
- Quinten Health, Lyon, France
| | | | | | - Joshua Nealon
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pok Fu Lam, Hong Kong Special Administrative Region of China
| | | | - Cedric Mahe
- Modelling, Epidemiology and Data Science, Sanofi Vaccines, Lyon, France
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2
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Simon S, Joean O, Welte T, Rademacher J. The role of vaccination in COPD: influenza, SARS-CoV-2, pneumococcus, pertussis, RSV and varicella zoster virus. Eur Respir Rev 2023; 32:230034. [PMID: 37673427 PMCID: PMC10481333 DOI: 10.1183/16000617.0034-2023] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/20/2023] [Indexed: 09/08/2023] Open
Abstract
Exacerbations of COPD are associated with worsening of the airflow obstruction, hospitalisation, reduced quality of life, disease progression and death. At least 70% of COPD exacerbations are infectious in origin, with respiratory viruses identified in approximately 30% of cases. Despite long-standing recommendations to vaccinate patients with COPD, vaccination rates remain suboptimal in this population.Streptococcus pneumoniae is one of the leading morbidity and mortality causes of lower respiratory tract infections. The Food and Drug Administration recently approved pneumococcal conjugate vaccines that showed strong immunogenicity against all 20 included serotypes. Influenza is the second most common virus linked to severe acute exacerbations of COPD. The variable vaccine efficacy across virus subtypes and the impaired immune response are significant drawbacks in the influenza vaccination strategy. High-dose and adjuvant vaccines are new approaches to tackle these problems. Respiratory syncytial virus is another virus known to cause acute exacerbations of COPD. The vaccine candidate RSVPreF3 is the first authorised for the prevention of RSV in adults ≥60 years and might help to reduce acute exacerbations of COPD. The 2023 Global Initiative for Chronic Lung Disease report recommends zoster vaccination to protect against shingles for people with COPD over 50 years.
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Affiliation(s)
- Susanne Simon
- Department of Respiratory Medicine and Infectious Disease, Hannover Medical School, Hannover, Germany
| | - Oana Joean
- Department of Respiratory Medicine and Infectious Disease, Hannover Medical School, Hannover, Germany
| | - Tobias Welte
- Department of Respiratory Medicine and Infectious Disease, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease, Member of the German Center for Lung Research, Hannover, Germany
| | - Jessica Rademacher
- Department of Respiratory Medicine and Infectious Disease, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease, Member of the German Center for Lung Research, Hannover, Germany
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3
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Lee JK, Lam GK, Yin JK, Loiacono MM, Samson SI. High-dose influenza vaccine in older adults by age and seasonal characteristics: Systematic review and meta-analysis update. Vaccine X 2023; 14:100327. [PMID: 37333054 PMCID: PMC10276206 DOI: 10.1016/j.jvacx.2023.100327] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/23/2023] [Accepted: 05/30/2023] [Indexed: 06/20/2023] Open
Abstract
This updated systematic review and meta-analysis of randomized and observational studies published up to April 2023 assessed the relative performance of high-dose inactivated influenza vaccine (HD-IIV) and standard-dose influenza vaccines (SD-IIV) against influenza-associated outcomes in older adults (≥65 years). The analysis included studies conducted over 12 influenza seasons (2009/2010 to 2019/2020, 2021/2022), including over 45 million individuals aged ≥ 65 years, and showed that HD-IIV provided significantly better protection than SD-IIV against influenza-like illness and influenza-related hospitalizations, as well as cardiovascular, cardiorespiratory, and all-cause hospitalizations. Subgroup analyses showed HD-IIV consistently provided better protection than SD-IIV against influenza outcomes across the age range (65+, 75+ 85+ years), and regardless of the predominantly circulating influenza strain and vaccine antigenic match/mismatch. Randomized studies continue to drive high-quality evidence on the effectiveness of high-dose inactivated influenza vaccine relative to SD-IIV against severe influenza outcomes in adults aged ≥ 65 years, supported by observational data.
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Affiliation(s)
- Jason K.H. Lee
- Leslie Dan School of Pharmacy, University of Toronto, Toronto, ON, Canada
- Sanofi, Toronto, ON, Canada
| | - Gary K.L. Lam
- Leslie Dan School of Pharmacy, University of Toronto, Toronto, ON, Canada
- Sanofi, Toronto, ON, Canada
| | - J. Kevin Yin
- University of Sydney, Camperdown, NSW, Australia
- Sanofi, Singapore
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4
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Chen J, Deng JC, Goldstein DR. How aging impacts vaccine efficacy: known molecular and cellular mechanisms and future directions. Trends Mol Med 2022; 28:1100-1111. [PMID: 36216643 PMCID: PMC9691569 DOI: 10.1016/j.molmed.2022.09.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/05/2022] [Accepted: 09/14/2022] [Indexed: 01/26/2023]
Abstract
Aging leads to a gradual dysregulation of immune functions, one consequence of which is reduced vaccine efficacy. In this review, we discuss several key contributing factors to the age-related decline in vaccine efficacy, such as alterations within the lymph nodes where germinal center (GC) reactions take place, alterations in the B cell compartment, alterations in the T cell compartment, and dysregulation of innate immune pathways. Additionally, we discuss several methods currently used in vaccine development to bolster vaccine efficacy in older adults. This review highlights the multifactorial defects that impair vaccine responses with aging.
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Affiliation(s)
- Judy Chen
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA; Program in Immunology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Jane C Deng
- Program in Immunology, University of Michigan, Ann Arbor, MI 48109, USA; Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI 48109, USA; Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA
| | - Daniel R Goldstein
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA; Program in Immunology, University of Michigan, Ann Arbor, MI 48109, USA.
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5
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Joean O, Welte T. Vaccination and modern management of chronic obstructive pulmonary disease - a narrative review. Expert Rev Respir Med 2022; 16:605-614. [PMID: 35713962 DOI: 10.1080/17476348.2022.2092099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) carries a tremendous societal and individual burden, posing significant challenges for public health systems worldwide due to its high morbidity and mortality. Due to aging and multimorbidity but also in the wake of important progress in deciphering the heterogeneous disease endotypes, an individualized approach to the prevention and management of COPD is necessary. AREAS COVERED This article tackles relevant immunization strategies that are available or still under development with a focus on the latest evidence but also controversies around different regional immunization approaches. Further, we present the crossover between chronic lung inflammation and lung microbiome disturbance as well as its role in delineating COPD endotypes. Moreover, the article attempts to underline endotype-specific treatment approaches. Lastly, we highlight non-pharmacologic prevention and management programs in view of the challenges and opportunities of the COVID-19 era. EXPERT OPINION Despite the remaining challenges, personalized medicine has the potential to offer tailored approaches to prevention and therapy and promises to improve the care of patients living with COPD.
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Affiliation(s)
- Oana Joean
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease, Member of the German Center for Lung Research, Hannover, Germany
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6
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Loiacono MM, Van Aalst R, Pokutnaya D, Mahmud SM, Nealon J. Methods to account for measured and unmeasured confounders in influenza relative vaccine effectiveness studies: A brief review of the literature. Influenza Other Respir Viruses 2022; 16:846-850. [PMID: 35545260 PMCID: PMC9343322 DOI: 10.1111/irv.12999] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/21/2022] [Indexed: 01/15/2023] Open
Abstract
Observational seasonal influenza relative vaccine effectiveness (rVE) studies employ a variety of statistical methods to account for confounding and biases. To better understand the range of methods employed and implications for policy, we conducted a brief literature review. Across 37 included rVE studies, 10 different types of statistical methods were identified, and only eight studies reported methods to detect residual confounding, highlighting the heterogeneous state of the literature. To improve the comparability and credibility of future rVE research, researchers should clearly explain methods and design choices and implement methods to detect and quantify residual confounding.
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Affiliation(s)
- Matthew M Loiacono
- Global Medical Evidence Generation, Sanofi, Swiftwater, Pennsylvania, USA
| | - Robertus Van Aalst
- Department of Modeling, Epidemiology, and Data Science, Sanofi, Lyon, France.,Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Darya Pokutnaya
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Salaheddin M Mahmud
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Joshua Nealon
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Global Medical Evidence Generation, Sanofi, Lyon, France
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7
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McMenamin ME, Bond HS, Sullivan SG, Cowling BJ. Estimation of Relative Vaccine Effectiveness in Influenza: A Systematic Review of Methodology. Epidemiology 2022; 33:334-345. [PMID: 35213508 PMCID: PMC8983951 DOI: 10.1097/ede.0000000000001473] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 01/31/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND When new vaccine components or platforms are developed, they will typically need to demonstrate noninferiority or superiority over existing products, resulting in the assessment of relative vaccine effectiveness (rVE). This review aims to identify how rVE evaluation is being performed in studies of influenza to inform a more standardized approach. METHODS We conducted a systematic search on PubMed, Google Scholar, and Web of Science for studies reporting rVE comparing vaccine components, dose, or vaccination schedules. We screened titles, abstracts, full texts, and references to identify relevant articles. We extracted information on the study design, relative comparison made, and the definition and statistical approach used to estimate rVE in each study. RESULTS We identified 63 articles assessing rVE in influenza virus. Studies compared multiple vaccine components (n = 38), two or more doses of the same vaccine (n = 17), or vaccination timing or history (n = 9). One study compared a range of vaccine components and doses. Nearly two-thirds of all studies controlled for age, and nearly half for comorbidities, region, and sex. Assessment of 12 studies presenting both absolute and relative effect estimates suggested proportionality in the effects, resulting in implications for the interpretation of rVE effects. CONCLUSIONS Approaches to rVE evaluation in practice is highly varied, with improvements in reporting required in many cases. Extensive consideration of methodologic issues relating to rVE is needed, including the stability of estimates and the impact of confounding structure on the validity of rVE estimates.
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Affiliation(s)
- Martina E. McMenamin
- From the 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, Hong Kong, China
| | - Helen S. Bond
- From the 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, Hong Kong, China
| | - Sheena G. Sullivan
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, Doherty Department, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Benjamin J. Cowling
- From the 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, Hong Kong, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong, China
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8
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Ferdinands JM, Patel M. Influence of disease attenuation on relative influenza vaccine effectiveness by vaccine type. Vaccine 2022; 40:2797-2801. [DOI: 10.1016/j.vaccine.2022.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 07/29/2021] [Accepted: 03/03/2022] [Indexed: 11/28/2022]
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9
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Comber L, O Murchu E, Jordan K, Hawkshaw S, Marshall L, O'Neill M, Teljeur C, Ryan M, Carnahan A, Pérez Martín JJ, Robertson AH, Johansen K, de Jonge J, Krause T, Nicolay N, Nohynek H, Pavlopoulou I, Pebody R, Penttinen P, Soler-Soneira M, Wichmann O, Harrington P. Systematic review of the efficacy, effectiveness and safety of high-dose seasonal influenza vaccines for the prevention of laboratory-confirmed influenza in individuals ≥18 years of age. Rev Med Virol 2022; 33:e2330. [PMID: 35119149 DOI: 10.1002/rmv.2330] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/16/2022] [Accepted: 01/18/2022] [Indexed: 12/24/2022]
Abstract
This review sought to assess the efficacy, effectiveness and safety of high-dose inactivated influenza vaccines (HD-IIV) for the prevention of laboratory-confirmed influenza in individuals aged 18 years or older. A systematic literature search was conducted in electronic databases and grey literature sources up to 7 February 2020. Randomised controlled trials (RCTs) and non-randomised studies of interventions (NRSIs) were included. The search returned 28,846 records, of which 36 studies were included. HD-IIV was shown to have higher relative vaccine efficacy in preventing influenza compared with standard-dose influenza vaccines (SD-IIV3) in older adults (Vaccine effectiveness (VE) = 24%, 95% CI 10-37, one RCT). One NRSI demonstrated significant effect for HD-IIV3 against influenza B (VE = 89%, 95% CI 47-100), but not for influenza A(H3N2) (VE = 22%, 95% CI -82 to 66) when compared with no vaccination in older adults. HD-IIV3 showed significant relative effect compared with SD-IIV3 for influenza-related hospitalisation (VE = 11.8%, 95% CI 6.4-17.0, two NRSIs), influenza- or pneumonia-related hospitalisation (VE = 13.7%, 95% CI 9.5-17.7, three NRSIs), influenza-related hospital encounters (VE = 13.1%, 95% CI 8.4-17.7, five NRSIs), and influenza-related office visits (VE = 3.5%, 95% CI 1.5-5.5, two NRSIs). For safety, HD-IIV were associated with significantly higher rates of local and systemic adverse events compared with SD-IIV (combined local reactions, pain at injection site, swelling, induration, headache, chills and malaise). From limited data, compared with SD-IIV, HD-IIV were found to be more effective in the prevention of laboratory-confirmed influenza, for a range of proxy outcome measures, and associated with more adverse events.
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Affiliation(s)
- Laura Comber
- Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Eamon O Murchu
- Health Information and Quality Authority (HIQA), Dublin, Ireland.,Department of Health Policy & Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Karen Jordan
- Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Sarah Hawkshaw
- Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Liam Marshall
- Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Michelle O'Neill
- Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Conor Teljeur
- Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Máirín Ryan
- Health Information and Quality Authority (HIQA), Dublin, Ireland.,Department of Pharmacology & Therapeutics, Trinity College Dublin, Trinity Health Sciences, Dublin, Ireland
| | - AnnaSara Carnahan
- European Centre for Disease Prevention and Control, EU/EEA National Immunisation Technical Advisory Group (NITAG) Collaboration on Newer and Enhanced Inactivated Seasonal Influenza Vaccines, Solna, Sweden.,Public Health Agency of Sweden, Solna, Sweden
| | - Jaime Jesús Pérez Martín
- European Centre for Disease Prevention and Control, EU/EEA National Immunisation Technical Advisory Group (NITAG) Collaboration on Newer and Enhanced Inactivated Seasonal Influenza Vaccines, Solna, Sweden.,General Directorate of Public Health and Addictions, IMIB-Arrixaca, Murcia University, Region of Murcia, Spain
| | - Anna Hayman Robertson
- European Centre for Disease Prevention and Control, EU/EEA National Immunisation Technical Advisory Group (NITAG) Collaboration on Newer and Enhanced Inactivated Seasonal Influenza Vaccines, Solna, Sweden.,Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Kari Johansen
- European Centre for Disease Prevention and Control, EU/EEA National Immunisation Technical Advisory Group (NITAG) Collaboration on Newer and Enhanced Inactivated Seasonal Influenza Vaccines, Solna, Sweden.,European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Jorgen de Jonge
- European Centre for Disease Prevention and Control, EU/EEA National Immunisation Technical Advisory Group (NITAG) Collaboration on Newer and Enhanced Inactivated Seasonal Influenza Vaccines, Solna, Sweden.,National Institute for Public Health and the Environment, Center for Infectious Disease Control, Bilthoven, The Netherlands
| | - Tyra Krause
- European Centre for Disease Prevention and Control, EU/EEA National Immunisation Technical Advisory Group (NITAG) Collaboration on Newer and Enhanced Inactivated Seasonal Influenza Vaccines, Solna, Sweden.,Statens Serum Institut, Copenhagen, Denmark
| | - Nathalie Nicolay
- European Centre for Disease Prevention and Control, EU/EEA National Immunisation Technical Advisory Group (NITAG) Collaboration on Newer and Enhanced Inactivated Seasonal Influenza Vaccines, Solna, Sweden.,European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Hanna Nohynek
- European Centre for Disease Prevention and Control, EU/EEA National Immunisation Technical Advisory Group (NITAG) Collaboration on Newer and Enhanced Inactivated Seasonal Influenza Vaccines, Solna, Sweden.,Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Ioanna Pavlopoulou
- European Centre for Disease Prevention and Control, EU/EEA National Immunisation Technical Advisory Group (NITAG) Collaboration on Newer and Enhanced Inactivated Seasonal Influenza Vaccines, Solna, Sweden.,Pediatric Research Laboratory, School of Health Sciences, Faculty of Nursing, National & Kapodistrian University of Athens, Goudi, Greece.,National Advisory Committee on Immunisation, Hellenic Ministry of Health, Athens, Greece
| | - Richard Pebody
- European Centre for Disease Prevention and Control, EU/EEA National Immunisation Technical Advisory Group (NITAG) Collaboration on Newer and Enhanced Inactivated Seasonal Influenza Vaccines, Solna, Sweden.,Institute of Epidemiology & Health, University College London, London, UK
| | - Pasi Penttinen
- European Centre for Disease Prevention and Control, EU/EEA National Immunisation Technical Advisory Group (NITAG) Collaboration on Newer and Enhanced Inactivated Seasonal Influenza Vaccines, Solna, Sweden.,European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Marta Soler-Soneira
- European Centre for Disease Prevention and Control, EU/EEA National Immunisation Technical Advisory Group (NITAG) Collaboration on Newer and Enhanced Inactivated Seasonal Influenza Vaccines, Solna, Sweden.,Vigilancia de Enfermedades Prevenibles por Vacunación, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación, Madrid, Spain
| | - Ole Wichmann
- European Centre for Disease Prevention and Control, EU/EEA National Immunisation Technical Advisory Group (NITAG) Collaboration on Newer and Enhanced Inactivated Seasonal Influenza Vaccines, Solna, Sweden.,Immunization Unit, Robert Koch-Institute, Berlin, Germany
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10
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Lewis NM, Chung JR, Uyeki TM, Grohskopf L, Ferdinands JM, Patel MM. Interpretation of Relative Efficacy and Effectiveness for Influenza Vaccines. Clin Infect Dis 2021; 75:170-175. [PMID: 34875035 DOI: 10.1093/cid/ciab1016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Indexed: 11/15/2022] Open
Abstract
Relative vaccine effectiveness (rVE) are metrics commonly reported to compare absolute VE (aVE) of two vaccine products. Estimates of rVE for enhanced influenza vaccines (eIV) vs. standard inactivated influenza vaccine (IIV) have been assessed across different seasons, influenza-specific endpoints, and nonspecific endpoints (e.g., all-cause cardiovascular hospitalizations). To illustrate the challenges of comparability across studies, we conducted a scenario analysis to evaluate the effects of varying absolute VE (aVE) of IIV (i.e., as compared with placebo) on the interpretation of rVE of eIV vs IIV. We show that estimates of rVE might not be comparable across studies because additional benefits commensurate with a given estimate of rVE are dependent on the aVE for the comparator vaccine, which can depend on factors such as host response to vaccine, virus type, and clinical endpoint evaluated. These findings have implications for interpretation of rVE across studies and for sample size considerations in future trials.
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Affiliation(s)
- Nathaniel M Lewis
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta Georgia, USA
| | - Jessie R Chung
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta Georgia, USA
| | - Timothy M Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta Georgia, USA
| | - Lisa Grohskopf
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta Georgia, USA
| | - Jill M Ferdinands
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta Georgia, USA
| | - Manish M Patel
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta Georgia, USA
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11
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Relative effectiveness of influenza vaccines in elderly persons in the United States, 2012/2013-2017/2018 seasons. NPJ Vaccines 2021; 6:108. [PMID: 34429431 PMCID: PMC8385076 DOI: 10.1038/s41541-021-00373-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 07/12/2021] [Indexed: 12/02/2022] Open
Abstract
Influenza immunization protects seniors against influenza and its potentially serious complications. It is uncertain whether standard-dose (SD) quadrivalent vaccine offers better protection over other formulations in the elderly. In this study, we compared the effectiveness of SD-trivalent, high-dose (HD) trivalent, SD-quadrivalent, and adjuvanted trivalent vaccines in seniors (≥65 years) in a real-world setting. We selected over 200,000 individuals in each of 6 influenza seasons from 2012 to 2018 using MarketScan® databases. The two outcomes were hospitalization or emergency room (ER) visit due to (1) influenza or (2) pneumonia. Here, SD-quadrivalent was associated with higher risk of influenza-related hospitalization/ER visit (adjusted hazard ratio (aHR) 1.14 and 95% confidence interval (95% CI) 1.05–1.24) and of pneumonia-related hospitalization/ER visit (aHR 1.04 and 95% CI 1.01–1.07) vs. HD-trivalent. SD-trivalent followed similar trends compared to HD-trivalent (aHR 1.16 and 95% CI 1.06–1.27 for hospitalized/ER visit influenza; aHR 1.07 and 95% CI 1.05–1.10 for hospitalized/ER visit pneumonia). We could not demonstrate risk differences between SD vaccine formulations and between adjuvanted trivalent and one of the other three vaccines. Risk estimates slightly varied across seasons. These findings suggest that SD vaccine formulations vs. HD-trivalent were associated with higher risk of hospitalization/ER visit for influenza and pneumonia in seniors.
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12
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Strain WD, Mansi J, Boikos C, Boivin M, Fisher WA. Achieving Influenza Vaccine Uptake Target in Canada via a Pharmacy-Led Telephone Discussion during the 2019-2020 Season. Vaccines (Basel) 2021; 9:vaccines9040312. [PMID: 33810215 PMCID: PMC8065524 DOI: 10.3390/vaccines9040312] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/18/2021] [Accepted: 03/20/2021] [Indexed: 01/03/2023] Open
Abstract
Older adults (≥65 years) are at elevated risk of influenza-related morbidity and mortality. Many developed countries do not achieve the World Health Organization influenza immunization target of 75% in people ≥65 years. We aimed to determine whether a brief pharmacy phone call could increase vaccine uptake of standard and enhanced influenza. Twenty-eight community pharmacists across Canada performed a telephone consultation with 643 older adults whose primary care records indicated that they had not received their influenza vaccination from their usual practitioner. Of these 643 adults, 169 (26.3%) had been vaccinated in another setting. Of the remaining 474, 313 (66%) agreed to receive the vaccine. Of those who refused vaccination, 69 provided a rationale for not wanting it, including that the flu shot "causes the flu" (n = 25), "doesn't work" (n = 25), "is too painful" (n = 10), and other (n = 10). Overall, of the 643 individuals who had not received their vaccination from their usual health care provider in the first wave of vaccinations, 75.4% (n = 485) ultimately received their vaccination in the 2019-2020 season. This highlights the important role of the community pharmacist in achieving the World Health Organization (WHO) targets for vaccination.
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Affiliation(s)
- William David Strain
- Diabetes and Vascular Research Centre, University of Exeter Medical School, Exeter EX2 5AX, UK
- Academic Department of Healthcare for Older People, Royal Devon & Exeter Hospital, Exeter EX2 5DW, UK
- Correspondence: ; Tel.: +441-392-403-058; Fax: +441-392-403-027
| | - James Mansi
- Centre for Outcomes Research & Evaluation (CORE), Seqirus, QC H9H 4M7, Canada; (J.M.); (C.B.)
| | - Constantina Boikos
- Centre for Outcomes Research & Evaluation (CORE), Seqirus, QC H9H 4M7, Canada; (J.M.); (C.B.)
| | - Michael Boivin
- Independent Pharmacist Consultant, Barrie, ON L4N 6Z6, Canada;
| | - William A. Fisher
- Department of Obstetrics and Gynaecology, Western University Canada, London, ON N6A 5C2, Canada;
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