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Stein AN, Mills CW, McGovern I, McDermott KW, Dean A, Bogdanov AN, Sullivan SG, Haag MDM. Relative Vaccine Effectiveness of Cell- vs Egg-Based Quadrivalent Influenza Vaccine Against Test-Confirmed Influenza Over 3 Seasons Between 2017 and 2020 in the United States. Open Forum Infect Dis 2024; 11:ofae175. [PMID: 38698895 PMCID: PMC11064727 DOI: 10.1093/ofid/ofae175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/20/2024] [Indexed: 05/05/2024] Open
Abstract
Background Influenza vaccine viruses grown in eggs may acquire egg-adaptive mutations that may reduce antigenic similarity between vaccine and circulating influenza viruses and decrease vaccine effectiveness. We compared cell- and egg-based quadrivalent influenza vaccines (QIVc and QIVe, respectively) for preventing test-confirmed influenza over 3 US influenza seasons (2017-2020). Methods Using a retrospective test-negative design, we estimated the relative vaccine effectiveness (rVE) of QIVc vs QIVe among individuals aged 4 to 64 years who had an acute respiratory or febrile illness and were tested for influenza in routine outpatient care. Exposure, outcome, and covariate data were obtained from electronic health records linked to pharmacy and medical claims. Season-specific rVE was estimated by comparing the odds of testing positive for influenza among QIVc vs QIVe recipients. Models were adjusted for age, sex, geographic region, influenza test date, and additional unbalanced covariates. A doubly robust approach was used combining inverse probability of treatment weights with multivariable regression. Results The study included 31 824, 33 388, and 34 398 patients in the 2017-2018, 2018-2019, and 2019-2020 seasons, respectively; ∼10% received QIVc and ∼90% received QIVe. QIVc demonstrated superior effectiveness vs QIVe in prevention of test-confirmed influenza: rVEs were 14.8% (95% CI, 7.0%-22.0%) in 2017-2018, 12.5% (95% CI, 4.7%-19.6%) in 2018-2019, and 10.0% (95% CI, 2.7%-16.7%) in 2019-2020. Conclusions This study demonstrated consistently superior effectiveness of QIVc vs QIVe in preventing test-confirmed influenza over 3 seasons characterized by different circulating viruses and degrees of egg adaptation.
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Affiliation(s)
- Alicia N Stein
- Centre for Outcomes Research and Epidemiology, CSL Seqirus, Melbourne, Australia
| | | | - Ian McGovern
- Centre for Outcomes Research and Epidemiology, CSL Seqirus, Waltham, Massachusetts, USA
| | | | - Alex Dean
- Real World Evidence, Veradigm, Chicago, Illinois, USA
| | | | - Sheena G Sullivan
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, and Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute of Infection and Immunity, Melbourne, Australia
- Department of Epidemiology, University of California, Los Angeles, California, USA
| | - Mendel D M Haag
- Centre for Outcomes Research and Epidemiology, CSL Seqirus, Amsterdam, Netherlands
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2
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Monto AS, Zambon M, Weir JP. The End of B/Yamagata Influenza Transmission - Transitioning from Quadrivalent Vaccines. N Engl J Med 2024; 390:1256-1258. [PMID: 38416423 DOI: 10.1056/nejmp2314801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Affiliation(s)
- Arnold S Monto
- From the Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor (A.S.M.); the U.K. Health Security Agency, London (M.Z.); and the Division of Viral Products, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD (J.P.W.)
| | - Maria Zambon
- From the Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor (A.S.M.); the U.K. Health Security Agency, London (M.Z.); and the Division of Viral Products, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD (J.P.W.)
| | - Jerry P Weir
- From the Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor (A.S.M.); the U.K. Health Security Agency, London (M.Z.); and the Division of Viral Products, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD (J.P.W.)
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3
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Fratty IS, Jurkowicz M, Zuckerman N, Nemet I, Atari N, Kliker L, Gur-Arie L, Rosenberg A, Glatman-Freedman A, Lustig Y, Mandelboim M. Influenza vaccine compatibility among hospitalized patients during and after the COVID-19 pandemic. Front Microbiol 2024; 14:1296179. [PMID: 38322758 PMCID: PMC10844098 DOI: 10.3389/fmicb.2023.1296179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/29/2023] [Indexed: 02/08/2024] Open
Abstract
Introduction Following the significant decrease in SARS-CoV-2 cases worldwide, Israel, as well as other countries, have again been faced with a rise in seasonal influenza. This study compared circulating influenza A and B in hospitalized patients in Israel with the influenza strains in the vaccine following the 2021-2022 winter season which was dominated by the omicron variant. Methods Nasopharyngeal samples of 16,325 patients were examined for the detection of influenza A(H1N1)pdm09, influenza A(H1N1)pdm09 and influenza B. Phylogenetic trees of hemagglutinin were then prepared using sanger sequencing. Vaccine immunogenicity was also performed using the hemagglutination inhibition test. Results Of the 16,325 nasopharyngeal samples collected from hospitalized patients between September 2021 (Week 40) and April 2023 (Week 15), 7.5% were found to be positive for influenza. Phylogenetic analyses show that in the 2021-2022 winter season, the leading virus subtype was influenza A(H3N2), belonging to clade 3C.2a1b.2a.2. However, the following winter season was dominated by influenza A(H1N1)pdm09, which belongs to clade 6B.aA.5a.2. The circulating influenza A(H1N1)pdm09 strain showed a shift from the vaccine strain, while the co-circulating influenza A(H3N2) and influenza B strains were similar to those of the vaccine. Antigenic analysis coincided with the sequence analysis. Discussion Influenza prevalence during 2022-2023 returned to typical levels as seen prior to the emergence of SARS-CoV-2, which may suggest a gradual viral adaptation to SARS-CoV-2 variants. Domination of influenza A(H1N1)pdm09 was observed uniquely in Israel compared to Europe and USA and phylogenetic and antigenic analysis showed lower recognition of the vaccine with the circulating influenza A(H1N1)pdm09 in Israel compared to the vaccine.
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Affiliation(s)
- Ilana S. Fratty
- Central Virology Laboratory, Public Health Services, Ministry of Health and Sheba Medical Center, Ramat-Gan, Israel
- The Israel Center for Disease Control, Israel Ministry of Health, Ramat-Gan, Israel
| | - Menucha Jurkowicz
- Central Virology Laboratory, Public Health Services, Ministry of Health and Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Department of Epidemiology and Preventive Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Neta Zuckerman
- Central Virology Laboratory, Public Health Services, Ministry of Health and Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Department of Epidemiology and Preventive Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ital Nemet
- Central Virology Laboratory, Public Health Services, Ministry of Health and Sheba Medical Center, Ramat-Gan, Israel
| | - Nofar Atari
- Central Virology Laboratory, Public Health Services, Ministry of Health and Sheba Medical Center, Ramat-Gan, Israel
| | - Limor Kliker
- Central Virology Laboratory, Public Health Services, Ministry of Health and Sheba Medical Center, Ramat-Gan, Israel
| | - Lea Gur-Arie
- The Israel Center for Disease Control, Israel Ministry of Health, Ramat-Gan, Israel
| | - Alina Rosenberg
- The Israel Center for Disease Control, Israel Ministry of Health, Ramat-Gan, Israel
| | - Aharona Glatman-Freedman
- The Israel Center for Disease Control, Israel Ministry of Health, Ramat-Gan, Israel
- Faculty of Medicine, Department of Epidemiology and Preventive Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yaniv Lustig
- Central Virology Laboratory, Public Health Services, Ministry of Health and Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Department of Epidemiology and Preventive Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Michal Mandelboim
- Central Virology Laboratory, Public Health Services, Ministry of Health and Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Department of Epidemiology and Preventive Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Levin MJ, Divino V, Postma MJ, Pelton SI, Zhou Z, DeKoven M, Mould-Quevedo J. A clinical and economic assessment of adjuvanted trivalent versus standard egg-derived quadrivalent influenza vaccines among older adults in the United States during the 2018-19 and 2019-20 influenza seasons. Expert Rev Vaccines 2024; 23:124-136. [PMID: 38073493 DOI: 10.1080/14760584.2023.2293237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/06/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Clinical evidence supports use of enhanced influenza vaccines in older adults. Few economic outcome studies have compared adjuvanted trivalent inactivated (aIIV3) and standard egg-derived quadrivalent inactivated influenza vaccines (IIV4e). RESEARCH DESIGN AND METHODS A retrospective cohort study was conducted leveraging deidentified US hospital data linked to claims data during the 2018-19 and 2019-20 influenza seasons. Relative vaccine effectiveness (rVE) was compared in adults aged ≥ 65 years receiving aIIV3 or IIV4e using inverse probability of treatment weighting (IPTW) and Poisson regression. An economic assessment quantified potential real-world cost savings. RESULTS The study included 715,807 aIIV3 and 320,991 IIV4e recipients in the 2018-19 and 844,169 aIIV3 and 306,270 IIV4e recipients in the 2019-20 influenza seasons. aIIV3 was significantly more effective than IIV4e in preventing cardiorespiratory disease (2018-19 rVE = 6.2%; and 2019-20 rVE = 6.0%) and respiratory disease (2018-19 rVE = 8.9%; and 2019-20 rVE = 10.1%). During the 2018-19 influenza season cardiorespiratory hospitalization cost savings for the aIIV3 population were $392 M, and $221 M for the 2019-20 season. Respiratory hospitalization cost savings for the aIIV3 population were $145 M and $97 M, respectively. CONCLUSIONS Our findings suggest that aIIV3 provides clinical and economic advantages versus IIV4e in the elderly.
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Affiliation(s)
- Myron J Levin
- Departments of Pediatrics and Medicine, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | | | - Maarten J Postma
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Economics, Econometrics and Finance, Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
- Centre of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Stephen I Pelton
- Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA
- Division of Pediatric Infectious Diseases, Maxwell Finland Laboratory, Boston Medical Center, Boston, MA, USA
| | - Zifan Zhou
- Real World Solutions, IQVIA, Falls Church, VA, USA
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Rothman E, Olsson O, Christiansen CB, Rööst M, Inghammar M, Karlsson U. Influenza A subtype H3N2 is associated with an increased risk of hospital dissemination - an observational study over six influenza seasons. J Hosp Infect 2023; 139:134-140. [PMID: 37419188 DOI: 10.1016/j.jhin.2023.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/15/2023] [Accepted: 06/22/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Previous studies on hospital-acquired influenza (HAI) have not systematically evaluated the possible impact of different influenza subtypes. HAI has historically been associated with high mortality, but clinical consequences may be less severe in a modern hospital setting. AIMS To identify and quantify HAI for each season, investigate possible associations with varying influenza subtypes, and to determine HAI-associated mortality. METHODS All influenza-PCR-positive adult patients (>18 years old) hospitalized in Skåne County during 2013-2019, were prospectively included in the study. Positive influenza samples were subtyped. Medical records of patients with suspected HAI were examined to confirm a nosocomial origin and to determine 30-day mortality. RESULTS Of 4110 hospitalized patients with a positive influenza PCR, 430 (10.5%) were HAI. Influenza A(H3N2) infections were more often HAI (15.1%) than influenza A(H1N1)pdm09, and influenza B (6.3% and 6.8% respectively, P<0.001). The majority of HAI caused by H3N2 were clustered (73.3 %) and were the cause of all 20 hospital outbreaks consisting of ≥4 affected patients. In contrast, the majority of HAI caused by influenza A(H1N1)pdm09 and influenza B were solitary cases (60% and 63.2%, respectively, P<0.001). Mortality associated with HAI was 9.3% and similar between subtypes. CONCLUSIONS HAI caused by influenza A(H3N2) was associated with an increased risk of hospital dissemination. Our study is relevant for future seasonal influenza infection control preparedness and shows that subtyping of influenza may help to define relevant infection control measures. Mortality in HAI remains substantial in a modern hospital setting.
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Affiliation(s)
- E Rothman
- Department of Clinical Microbiology and Infection Prevention and Control, Skåne University Hospital, Sweden; Department of Research and Development, Region Kronoberg, Växjö, Sweden
| | - O Olsson
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden; Department of Infectious Diseases, Skåne University Hospital, Lund, Sweden
| | - C B Christiansen
- Department of Clinical Microbiology and Infection Prevention and Control, Skåne University Hospital, Sweden
| | - M Rööst
- Department of Research and Development, Region Kronoberg, Växjö, Sweden; Department of Clinical Sciences in Malmö, Family Medicine, Clinical Research Centre, Lund University, Malmö, Sweden
| | - M Inghammar
- Department of Infectious Diseases, Skåne University Hospital, Lund, Sweden; Section for Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - U Karlsson
- Department of Clinical Microbiology and Infection Prevention and Control, Skåne University Hospital, Sweden; Section for Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden.
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