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J Infect Dis. 2018 Dec 18. doi: 10.1093/infdis/jiy716. [Epub ahead of print]

Relative effectiveness of cell-cultured and egg-based influenza vaccines among the U.S. elderly, 2017-18.

Author information

1
Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA.
2
PhD. candidate, Universidad Rey Juan Carlos, Spain.
3
Acumen LLC, Burlingame, CA, USA.
4
Centers for Medicare and Medicaid Services, Washington DC, USA.

Abstract

Background:

The low influenza vaccine effectiveness (VE) observed during the A(H3N2)-dominated 2017-18 season may be due to vaccine virus adaptation to growth in eggs. We compared effectiveness of cell-cultured and egg-based vaccines among Medicare beneficiaries.

Methods:

Retrospective cohort study on beneficiaries ages ≥65 years who received an influenza vaccine (cell-cultured, egg-based quadrivalent; egg-based high-dose, adjuvanted, or standard-dose trivalent) during the 2017-18 season. We used Poisson regression to evaluate relative VE (RVE) in preventing influenza hospital encounters.

Results:

Of >13 million beneficiaries, RVE for cell-cultured vaccines relative to egg-based quadrivalent vaccines was 10% (95% CI: 7% to 13%). In a mid-season interim analysis, this estimate was 16.5% (95% CI: 10.3% to 22.2%). In a five-way comparison, cell-cultured (RVE 11%, 95% CI: 8% to 14%) and egg-based high-dose (RVE 8%, 95% CI: 7% to 10%) vaccines were more effective than egg-based quadrivalent vaccines.

Conclusions :

he modest VE difference between cell-cultured and egg-based vaccines only partially explains the low overall VE reported by CDC, suggesting egg adaptation was not the main contributor to the low VE found among individuals ages ≥65 years. The mid-season interim analysis we performed demonstrates that our methods can be used to evaluate VE actively during the flu season.

PMID:
30561688
DOI:
10.1093/infdis/jiy716

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