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Relative effectiveness of influenza vaccines in elderly persons in the United States, 2012/2013-2017/2018 seasons.

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.

SUBMITTER: Machado MAA

PROVIDER: S-EPMC8385076 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundThe health of the elderly is one of the major challenges in today's ageing society. However, research on infectious diseases among the elderly is limited. This study aimed to describe the epidemiological characteristics and dynamics of infectious diseases among the elderly population aged ≥60 years in Shandong province, China.MethodsIncidence data for infectious diseases were collected from the Shandong Multi-Center Healthcare Big Data Platform from January 2013 to June 2017, which involved 550 432 elderly persons. We compared the incidence of each infectious disease and disease category, stratified by age, gender, and region. Annual percentage change (APC) was estimated using logarithmic linear regression to examine the incidence trends. Poisson regression was conducted to identify the effect of demographic factors on incidence, with incidence rate ratio (IRR) and their 95% confidence intervals (CIs) estimated.ResultsA total of 27 595 cases of 102 infectious diseases were reported during the study period, with an overall incidence of 1425.51/100 000 person-years. The most common infectious diseases were respiratory and mucocutaneous diseases among the elderly persons, with annual increases of 17.45% and 20.44%, respectively (both P<0.05). In rural areas, the incidence of respiratory, gastrointestinal, blood- and sex-transmitted, and mucocutaneous infections increased significantly, with APCs of 178.52%, 204.66%, 28.24%, 63.01%, respectively (all P<0.05). Elderly males had a higher risk of infections than that of females, with the highest IRRa of 2.94 (95% confidence interval (CI) = 2.89, 3.00) in respiratory diseases. The elderly aged 85-89 years had a much higher risk of respiratory diseases than those aged 60-64 years (IRRa = 9.85, 95%CI: 9.39, 10.33); however, the risk of blood- and sex-transmitted diseases was highest among the elderly aged 65-69 years (IRRa = 1.24, 95% CI = 1.06, 1.45).ConclusionsAgeing population are facing a substantial challenge on infectious diseases. More attention should be paid to infections with significant growth. Targeted strategies and measures on elderly persons in different regions and subgroups are urgently needed.

Project description: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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Relative effectiveness of influenza vaccines in elderly persons in the United States, 2012/2013-2017/2018 seasons.

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