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Influenza vaccine effectiveness in older adults compared with younger adults over five seasons.

ABSTRACT: BACKGROUND:There have been inconsistent reports of decreased vaccine effectiveness (VE) against influenza viruses among older adults (aged???65?years) compared with younger adults in the United States. A direct comparison of VE over multiple seasons is needed to assess the consistency of these observations. METHODS:We performed a pooled analysis of VE over 5 seasons among adults aged???18?years who were systematically enrolled in the U.S. Flu VE Network. Outpatients with medically-attended acute respiratory illness (cough with illness onset???7?days prior to enrollment) were tested for influenza by reverse transcription polymerase chain reaction. We compared differences in VE and vaccine failures among older adult age group (65-74, ?75, and???65?years) to adults aged 18-49?years by influenza type and subtype using interaction terms to test for statistical significance and stratified by prior season vaccination status. RESULTS:Analysis included 20,022 adults aged???18?years enrolled during the 2011-12 through 2015-16 influenza seasons; 4,785 (24%) tested positive for influenza. VE among patients aged???65?years was not significantly lower than VE among patients aged 18-49?years against any subtype with no significant interaction of age and vaccination. VE against A(H3N2) viruses was 14% (95% confidence interval [CI] -14% to 36%) for adults???65?years and 21% (CI 9-32%) for adults 18-49?years. VE against A(H1N1)pdm09 was 49% (95% CI 22-66%) for adults???65?years and 48% (95% CI 41-54%) for adults 18-49?years and against B viruses was 62% (95% CI 44-74%) for adults???65?years and 55% (95% CI 45-63%) for adults 18-49?years. There was no significant interaction of age and vaccination for separate strata of prior vaccination status. CONCLUSIONS:Over 5 seasons, influenza vaccination provided similar levels of protection among older and younger adults, with lower levels of protection against influenza A(H3N2) in all ages.

SUBMITTER: Russell K

PROVIDER: S-EPMC5812289 | biostudies-literature | 2018 Feb

REPOSITORIES: biostudies-literature

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Influenza vaccine effectiveness in older adults compared with younger adults over five seasons.

Russell Kate K Chung Jessie R JR Monto Arnold S AS Martin Emily T ET Belongia Edward A EA McLean Huong Q HQ Gaglani Manjusha M Murthy Kempapura K Zimmerman Richard K RK Nowalk Mary Patricia MP Jackson Michael L ML Jackson Lisa A LA Flannery Brendan B

Vaccine 20180201 10

<h4>Background</h4>There have been inconsistent reports of decreased vaccine effectiveness (VE) against influenza viruses among older adults (aged ≥ 65 years) compared with younger adults in the United States. A direct comparison of VE over multiple seasons is needed to assess the consistency of these observations.<h4>Methods</h4>We performed a pooled analysis of VE over 5 seasons among adults aged ≥ 18 years who were systematically enrolled in the U.S. Flu VE Network. Outpatients with medically ...[more]

PMID: 29402578

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Project description:IntroductionTrivalent influenza vaccines (TIVs) are currently reimbursed for subjects aged ≥ 65 years and children between 6 and 59 months of age under a national immunization program in South Korea. Quadrivalent influenza vaccines (QIVs) are expected to address the potential problem of influenza B-lineage mismatch for TIVs.ObjectiveThe objective of this analysis was to compare the cost effectiveness of QIV versus TIV in children aged 6-59 months and older adults ≥ 65 years of age in South Korea.MethodsA 1-year static population model was employed to compare the costs and outcomes of a QIV vaccination program compared with TIV in children aged 6-59 months and older adults ≥ 65 years of age in South Korea. Influenza-related parameters (probabilities, health resource use, and costs) were derived from an analysis of the National Health Insurance System claims database between 2010 and 2013 under a broad and narrow set of International Classification of Diseases, Tenth Revision (ICD-10) codes used to identify influenza. Other inputs were extracted from published literature. Incremental cost-effectiveness ratios (2016 South Korean Won [KRW] per quality-adjusted life-year [QALY] gained) were estimated using a 'limited' societal perspective as per the Korean pharmacoeconomic guidelines. QALYs lost due to premature mortality were discounted at 5% annually.ResultsFor both age groups combined, under the narrow definition of influenza, QIV is expected to prevent nearly 16,000 (2923 in children and 13,011 in older adults) medically attended influenza cases, nearly 8000 (672 in children, 7048 in older adults) cases of complications, and over 230 (0 in children, 238 in older adults) deaths annually compared with TIV. The impact of using QIV versus TIV in this setting translates into savings of KRW 24 billion (KRW 0.6 billion in children, KRW 23.4 billion in older adults) in annual medical costs, and over 2100 (18 in children, 2084 in older adults) QALYs. Under the broad definition, the corresponding results are over 190,000 (50,697 in children, 140,644 in older adults) influenza cases, over 37,000 (12,623 in children, 24,526 in older adults) complications, 270 deaths (0 in children, 270 in older adults), KRW 94.22 billion (KRW 16 billion in children, KRW 78.2 billion in older adults), and over 3500 QALYs saved (316 in children, 3260 in older adults).ConclusionThe use of QIV over TIV was estimated to not be cost effective in children 6-59 months of age, but cost saving in older adults, using the narrow definition of influenza; however, QIV use was cost saving in both age groups using the broad definition. QIV is expected to yield more benefits in older adults ≥ 65 years of age than in children aged 6-59 months due to higher influenza-related mortality and costs among the older adults. Further analyses considering the indirect effects of influenza vaccination in children are required.

Dataset Information

Influenza vaccine effectiveness in older adults compared with younger adults over five seasons.

Publications

Influenza vaccine effectiveness in older adults compared with younger adults over five seasons.

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