scholarly journals Comparative effectiveness of influenza vaccines among U.S. Medicare beneficiaries ages 65 years and older during the 2019-20 season

2020 ◽  
Author(s):  
Hector S Izurieta ◽  
Michael Lu ◽  
Jeffrey Kelman ◽  
Yun Lu ◽  
Arnstein Lindaas ◽  
...  
Keyword(s):  
Standard Dose ◽  
The Elderly ◽  
Influenza Vaccines ◽  
Influenza B ◽  
High Dose ◽  
Medicare Beneficiaries ◽  
Health Seeking ◽  
Inverse Probability ◽  
Seeking Behavior ◽  
The U.S

Abstract Background Around 50,000 influenza-associated deaths occur annually in the U.S., overwhelmingly among individuals ages >65 years. Although vaccination is the primary prevention tool, investigations have shown low vaccine effectiveness (VE) in recent years, particularly among the elderly. We analyzed the relative VE (RVE) of all influenza vaccines among Medicare beneficiaries ages >65 years to prevent influenza hospital encounters during the 2019-20 season. Methods Retrospective cohort study using Poisson regression and inverse probability of treatment weighting (IPTW). Exposures included egg-based high-dose trivalent (HD-IIV3), egg-based adjuvanted trivalent (aIIV3), egg-based standard dose (SD) quadrivalent (IIV4), cell-based SD quadrivalent (cIIV4), and recombinant quadrivalent (RIV4) influenza vaccines. Results We studied 12.7 million vaccinated beneficiaries. Following IPTW, cohorts were well balanced for all covariates and health-seeking behavior indicators. In the adjusted analysis, RIV4 (RVE 13.3%, 95% CI 7.4%, 18.9%), aIIV3 (RVE 8.2%, 95% CI 4.2%, 12.0%), and HD-IIV3 (RVE 6.8%, 95% CI 3.3%, 10.1%) were significantly more effective in preventing hospital encounters than the reference egg-based SD IIV4, while cIIV4 was not significantly more effective than IIV4 (RVE 2.8%, 95% CI -2.8%, 8.2%). Our results were consistent across all analyses. Conclusions In this influenza B-Victoria and A(H1N1)-dominated season, RIV4 was moderately more effective than other vaccines, while the HD-IIV3 and aIIV3 were more effective than the IIV4 vaccines, highlighting the contributions of antigen amount and adjuvant use to VE. Egg adaptation likely did not substantially affect our RVE evaluation. Our findings, specific to the 2019-20 season, should be evaluated in other studies using virological case confirmation.

scholarly journals Relative Effectiveness of Influenza Vaccines Among the United States Elderly, 2018–2019

2020 ◽  
Vol 222 (2) ◽  
pp. 278-287 ◽  
Author(s):  
Hector S Izurieta ◽  
Yoganand Chillarige ◽  
Jeffrey Kelman ◽  
Yuqin Wei ◽  
Yun Lu ◽  
...  
Keyword(s):  
Standard Dose ◽  
Relative Effectiveness ◽  
The Elderly ◽  
The United States ◽  
Influenza Vaccines ◽  
Quadrivalent Vaccine ◽  
High Dose ◽  
Medicare Beneficiaries ◽  
Inverse Probability ◽  
Quadrivalent Vaccines

Abstract Background Studies among individuals ages ≥65 years have found a moderately higher relative vaccine effectiveness (RVE) for the high-dose (HD) influenza vaccine compared with standard-dose (SD) products for most seasons. Studies during the A(H3N2)-dominated 2017–2018 season showed slightly higher RVE for the cell-cultured vaccine compared with SD egg-based vaccines. We investigated the RVE of influenza vaccines among Medicare beneficiaries ages ≥65 years during the 2018–2019 season. Methods This is a retrospective cohort study using inverse probability of treatment weighting and Poisson regression to evaluate RVE in preventing influenza hospital encounters. Results Among 12 777 214 beneficiaries, the egg-based adjuvanted (RVE, 7.7%; 95% confidence interval [CI], 3.9%–11.4%) and HD (RVE, 4.9%; 95% CI, 1.7%–8.1%) vaccines were marginally more effective than the egg-based quadrivalent vaccines. The cell-cultured quadrivalent vaccine was not significantly more effective than the egg-based quadrivalent vaccine (RVE, 2.5%; 95% CI, −2.4% to 7.3%). Conclusions We did not find major effectiveness differences between licensed vaccines used among the elderly during the 2018–2019 season. Consistent with prior research, we found that the egg-based adjuvanted and HD vaccines were slightly more effective than the egg-based quadrivalent vaccines.

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

npj Vaccines ◽  
2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Marina Amaral de Avila Machado ◽  
Cristiano S. Moura ◽  
Michal Abrahamowicz ◽  
Brian J. Ward ◽  
Louise Pilote ◽  
...  
Keyword(s):  
Standard Dose ◽  
Relative Effectiveness ◽  
The Elderly ◽  
The United States ◽  
The Other ◽  
Influenza Vaccines ◽  
Quadrivalent Vaccine ◽  
High Dose ◽  
Elderly Persons ◽  
Real World Setting

AbstractInfluenza 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.

Effect of Age on Relative Effectiveness of High-Dose Versus Standard-Dose Influenza Vaccines Among US Medicare Beneficiaries Aged ≥65 Years

2019 ◽  
Vol 220 (9) ◽  
pp. 1511-1520 ◽  
Author(s):  
Yun Lu ◽  
Yoganand Chillarige ◽  
Hector S Izurieta ◽  
Yuqin Wei ◽  
Wenjie Xu ◽  
...  
Keyword(s):  
Standard Dose ◽  
Relative Effectiveness ◽  
Emergency Department Visits ◽  
Influenza Vaccines ◽  
High Dose ◽  
Medicare Beneficiaries ◽  
Poisson Models ◽  
Effect Of Age ◽  
Pharmacy Setting ◽  
Dose Vaccine

AbstractBackgroundStudies have found that the high-dose influenza vaccine has a higher relative vaccine effectiveness (RVE) versus standard-dose vaccines in some seasons. We evaluated the effect of age on the RVE of high-dose versus standard-dose influenza vaccines among Medicare beneficiaries.MethodsA 6-season retrospective cohort study from 2012 to 2018 among Medicare beneficiaries aged ≥65 years was performed. Poisson regression was used to evaluate the effect of age on the RVE of high-dose versus standard-dose influenza vaccines in preventing influenza-related hospitalizations.ResultsThe study included >19 million vaccinated beneficiaries in a community pharmacy setting. The Poisson models indicated a slightly increasing trend in RVE with age in all seasons. The high-dose vaccine was more effective than standard-dose vaccines in preventing influenza-related hospital encounters (ie, influenza-related inpatient stays and emergency department visits) in the 2012–2013 (RVE, 23.1%; 95% confidence interval [CI], 17.6%–28.3%), 2013–2014 (RVE, 15.3%; 95% CI, 7.8%–22.3%), 2014–2015 (RVE, 8.9%; 95% CI, 5.6%–12.1%), and 2016–2017 (RVE, 12.6%; 95% CI, 6.3%–18.4%) seasons and was at least as effective in all other seasons. We also found that the high-dose vaccine was consistently more effective than standard-dose vaccines across all seasons for people aged ≥85 years. Similar trends were observed for influenza-related inpatient stays.ConclusionsThe RVE of high-dose versus standard-dose influenza vaccines increases with age.

scholarly journals Analysis of relative effectiveness of high-dose versus standard-dose influenza vaccines using an instrumental variable method

Vaccine ◽  
2019 ◽  
Vol 37 (11) ◽  
pp. 1484-1490 ◽  
Author(s):  
Yinong Young-Xu ◽  
Julia Thornton Snider ◽  
Robertus van Aalst ◽  
Salaheddin M. Mahmud ◽  
Edward W. Thommes ◽  
...  
Keyword(s):  
Instrumental Variable ◽  
Standard Dose ◽  
Relative Effectiveness ◽  
Variable Method ◽  
Influenza Vaccines ◽  
High Dose ◽  
Instrumental Variable Method

scholarly journals Assessment of Health Seeking Behavior of Gestational Diabetes in Pregnancy among Elderly Primi Mother

2021 ◽  
pp. 261-267
Author(s):  
Prachi Dhale ◽  
Pragati Dhawale ◽  
Amrin Dosani ◽  
Gaurav Dongare ◽  
Bali Thool
Keyword(s):  
Blood Glucose ◽  
Gestational Diabetes ◽  
Adverse Pregnancy Outcome ◽  
The Elderly ◽  
Diabetes In Pregnancy ◽  
Health Seeking ◽  
Health Seeking Behavior ◽  
Increased Risk ◽  
Seeking Behavior ◽  
In Pregnancy

Introduction: Gestational diabetes mellitus (GDM) is diagnosed by elevated blood glucose in pregnancy though the definition has changed repeatedly since its first description in the 1960’s. The most frequently reported perinatal consequence of GDM is macrosomia (usually defined as a neonate weighing over 4 kg) which can increase the risk of caesarean section and shoulder dystocia. For the mother, there are also potential longer-term consequences including an increased risk of type 2 diabetes post-pregnancy and/or in later life. The investigators of a large international Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study aimed to identify a cut-point in the continuum to decide the blood glucose level (BGL) thresholds that should be used to define GDM. Objective: To assess the incidence rate of gestational diabetes in pregnancy among the elderly primi mother. To assess the health seeking behavior of gestational diabetes in elderlyprimimothers.  To associate the demographic variables of gestational diabetes in elderly primi mothers. Materials and Methods: A Descriptive research study was to assess the incidence and Health seeking behavior of gestational diabetes in pregnancy among the elderly primi mother. The target population for the study includes all antenatal women (12-36 weeks of gestation) who attend the antenatal clinics of AVBRH Out Patient Department. Sample consists of sub set of units that compose accessible population. In this study sample size was 100 elderly primi mother of selected area of community of Wardha. A tool is an instrument or equipment used for collection of data. A blue print was prepared prior to the construction of knowledge questionnaire based on which items were developed. Results: A finding shows that (41%) were having good, (40%) were having very good, (17%) were having average and (2%) were having excellent knowledge score. The minimum score was 05 and maximum score was 14, the mean score for the test was 8.93 ± 2.23 and mean percentage of knowledge was 59.54%. There was no significant association in relation to age, education, occupation, No.of gravida, income etc.

scholarly journals LB14. Safety and Immunogenicity of High-Dose Quadrivalent Influenza Vaccine Administered by Intramuscular Route in Subjects Aged 65 Years and Older

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S764-S764 ◽  
Author(s):  
Lee-Jah Chang ◽  
Ya Meng ◽  
Helene Janosczyk ◽  
Victoria Landolfi ◽  
H Keipp Talbot ◽  
...  
Keyword(s):  
United States ◽  
Immune Response ◽  
Influenza Vaccine ◽  
Standard Dose ◽  
The United States ◽  
Influenza Vaccines ◽  
High Dose ◽  
Post Vaccination ◽  
B Lineage ◽  
Research Grant

Abstract Background Older adults (≥65 years of age) remain at increased risk of influenza because they do not respond to standard dose influenza vaccines as well as younger adults. A high dose, inactivated trivalent influenza vaccine, IIV3-HD, containing four times the antigen content (60 µg hemagglutinin per influenza strain) of standard-dose influenza vaccines has been available in the United States since 2010. Two distinct B influenza lineages (Victoria and Yamagata) have co-circulated for over a decade, making it difficult to predict which will predominate the next season. IIV4-HD has been developed to address the frequent influenza B strain mismatches by incorporating a strain from each B lineage. This pivotal Phase III study evaluated the safety and immunogenicity of IIV4-HD as compared with two IIV3-HD vaccines. Method A randomized, modified double-blind, multicenter study (NCT03282240) was conducted in 2670 healthy subjects in the United States, who were randomly assigned to receive IIV4-HD, a licensed IIV3-HD, or an IIV3-HD with the alternate B influenza strain. Using the hemagglutinin inhibition (HAI) assay at baseline and 28 days after vaccination, post-vaccination geometric mean titers and seroconversion rates were measured. Safety data were collected through 6 months post-vaccination. Result IIV4-HD was noninferior to the licensed IIV3-HD and the investigational IIV3-HD (containing the alternate B strain) for all four influenza strains as assessed by HAI GMTs and seroconversion rates. Moreover, IIV4-HD induced a superior immune response (HAI GMTs and seroconversion rates) compared with the immune response induced by the IIV3-HD that does not contain the corresponding B strain. Reactogenicity profiles were comparable across all study groups. Most unsolicited adverse events were of Grade 1 or Grade 2 intensity. One serious adverse event considered related by the Investigator was reported in the IIV4-HD group. Conclusion Vaccination of adults 65 years of age and older with IIV4-HD was found to be noninferior to two IIV3-HD vaccines with a similar safety profile. The addition of a second B lineage strain does not adversely affect the safety or immunogenicity profile of IIV4-HD compared with IIV3-HD. Disclosures L. J. Chang, Sanofi Pasteur: Employee, Salary. Y. Meng, Sanofi Pasteur: Employee, Salary. H. Janosczyk, Sanofi Pasteur: Employee, Salary. V. Landolfi, Sanofi Pasteur: Employee, Salary. H. K. Talbot, Sanofi Pasteur: Investigator, Research grant. Gilead: Investigator, Research grant. MedImmune: Investigator, Research grant. Vaxinnate: Safety Board, none. Seqirus: Safety Board, none.

Relative vaccine efficacy of high-dose versus standard-dose influenza vaccines in preventing probable influenza in a Medicare Fee-for-Service population

Vaccine ◽  
2020 ◽  
Vol 38 (29) ◽  
pp. 4548-4556 ◽  
Author(s):  
Misti Paudel ◽  
Salah Mahmud ◽  
Ami Buikema ◽  
Stephanie Korrer ◽  
Damon Van Voorhis ◽  
...  
Keyword(s):  
Vaccine Efficacy ◽  
Standard Dose ◽  
Influenza Vaccines ◽  
High Dose ◽  
Fee For Service

Providing Additional “Muscle” for Older Adults Through Optimal Influenza Vaccine Selection

2018 ◽  
Vol 52 (9) ◽  
pp. 936-941 ◽  
Author(s):  
John A. Dougherty ◽  
Elias B. Chahine
Keyword(s):  
Older Adults ◽  
Influenza Vaccine ◽  
Disease Control ◽  
Older Patients ◽  
Standard Dose ◽  
Influenza Vaccines ◽  
High Dose ◽  
Control And Prevention ◽  
Reasonable Evidence ◽  
Age Appropriate

Immunization is the best strategy to protect individuals from influenza; however, older adults tend to respond less favorably to vaccines because of immunosenescence. The Centers for Disease Control and Prevention states that any licensed, recommended, and age-appropriate influenza vaccine may be used in older adults despite reasonable evidence suggesting that the high-dose and, to a lesser extent, the adjuvanted and recombinant influenza vaccines provide better protection than the standard-dose vaccines in this vulnerable population. In this era of precision medicine, clinicians can preferentially recommend these contemporary vaccines to equip their older patients with the best possible protection against influenza.

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