Association between hemagglutination inhibition antibody titers and protection against RT-PCR confirmed influenza illness in children 6−35 months of age: statistical evaluation of a correlate of protection
Abstract Background Data from a randomized, controlled efficacy trial of an inactivated quadrivalent influenza vaccine in children 6−35 months of age were used to determine whether hemagglutination inhibition (HI) antibody titer against A/H1N1 and A/H3N2 is a statistical correlate of protection (CoP) for the risk of RT-PCR-confirmed influenza associated with the corresponding strain. Methods The Prentice criteria were used to statistically validate strain-specific HI antibody titer as a CoP. The probability of protection was identified using Dunning's model corresponding to a pre-specified probability of protection at an individual level. The group level protective threshold was identified using Siber's approach, leading to unbiased predicted vaccine efficacy (VE). A case-cohort sub-sample was used for this exploratory analysis. Results Prentice criteria confirmed that HI titer is a statistical CoP for RT-PCR-confirmed influenza. Dunning's model predicted a probability of protection of 49.7% against A/H1N1 influenza and 54.7% against A/H3N2 influenza at an HI antibody titer of 1:40 for the corresponding strain. Higher titers of 1:320 were associated with more than 80% probability of protection. Siber's method predicted VE of 61.0% at a threshold of 1:80 for A/H1N1 and 46.6% at 1:113 for A/H3N2. Conclusions The study validated HI antibody titer as a statistical CoP, by demonstrating that HI titer is correlated with clinical protection against RT-PCR-confirmed influenza associated with the corresponding influenza strain and is predictive of VE in children 6−35 months of age.