Effectiveness of live attenuated influenza vaccine and inactivated influenza vaccine in children 2–17 years of age in 2013–2014 in the United States

Caspard, Hervé; Gaglani, Manjusha; Clipper, Lydia; Belongia, Edward A.; McLean, Huong Q.; Griffin, Marie R.; Talbot, H. Keipp; Poehling, Katherine A.; Peters, Timothy R.; Veney, Naomi; Ambrose, Christopher S.

doi:10.1016/j.vaccine.2015.11.010

Cited by 64 publications

(58 citation statements)

References 12 publications

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“…LAIV had low VE in 2013-2014 [3,17,18], possibly due to the heat instability of the A/H1N1 [19,20] construct, which was changed for the 2015-2016 vaccine. A review of LAIV VE over several past years of the US Flu VE Network also failed to find superiority of LAIV [21].…”

Section: Discussionmentioning

confidence: 99%

2014–2015 Influenza Vaccine Effectiveness in the United States by Vaccine Type

et al. 2016

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Background. Circulating A/H3N2 influenza viruses drifted significantly after strain selection for the 2014-2015 vaccines. Also in 2014-2015, the Advisory Committee on Immunization Practices recommended preferential use of live attenuated influenza vaccine (LAIV) over inactivated influenza vaccine (IIV) among children aged 2-8 years.Methods. Vaccine effectiveness (VE) across age groups and vaccine types was examined among outpatients with acute respiratory illness at 5 US sites using a test-negative design, that compared the odds of vaccination among reverse transcription polymerase chain reaction-confirmed influenza positives and negatives.Results. Of 9311 enrollees with complete data, 7078 (76%) were influenza negative, 1840 (19.8%) were positive for influenza A (A/H3N2, n = 1817), and 395 (4.2%) were positive for influenza B (B/Yamagata, n = 340). The overall adjusted VE was 19% (95% confidence interval [CI], 10% to 27%) and was statistically significant in all age strata except those aged 18-64 years. The adjusted VE of 6% (95%CI, −5% to 17%) against A/H3N2-associated illness was not statistically significant, unlike VE for influenza B/Yamagata, which was 55% (95%CI, 43% to 65%). Among those aged 2-8 years, VE against A/H3N2 was 15% (95%CI, −16% to 38%) for IIV and −3% (CI, −50% to 29%) for LAIV; VE against B/Yamagata was 40% (95%CI, −20% to 70%) for IIV and 74% (95%CI, 25% to 91%) for LAIV.Conclusions. The 2014-2015 influenza vaccines offered little protection against the predominant influenza A/H3N2 virus but were effective against influenza B. Preferential use of LAIV among young children was not supported.

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Section: Discussionmentioning

confidence: 99%

2014–2015 Influenza Vaccine Effectiveness in the United States by Vaccine Type

et al. 2016

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“…A recent important finding of the Influenza Vaccine Effectiveness Network, 8 later confirmed by other studies, 11,12 was that the quadrivalent live attenuated influenza vaccine lacked effectiveness against A(H1N1)pdm09 viruses in young children during the 2013–2014 influenza season. 8 This occurred in a season in which trivalent and quadrivalent inactivated influenza vaccines were effective at preventing influenza, indicating that the failure of the live attenuated vaccine was not due to a poor match between vaccines and circulating A(H1N1)pdm09 strains.…”

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confidence: 83%

Influenza Vaccine Effectiveness in the United States during the 2015–2016 Season

Jackson¹,

Chung²,

Jackson³

et al. 2017

N Engl J Med

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BACKGROUND The A(H1N1)pdm09 virus strain used in the live attenuated influenza vaccine was changed for the 2015–2016 influenza season because of its lack of effectiveness in young children in 2013–2014. The Influenza Vaccine Effectiveness Network evaluated the effect of this change as part of its estimates of influenza vaccine effectiveness in 2015–2016. METHODS We enrolled patients 6 months of age or older who presented with acute respiratory illness at ambulatory care clinics in geographically diverse U.S. sites. Using a test-negative design, we estimated vaccine effectiveness as (1 – OR) × 100, in which OR is the odds ratio for testing positive for influenza virus among vaccinated versus unvaccinated participants. Separate estimates were calculated for the inactivated vaccines and the live attenuated vaccine. RESULTS Among 6879 eligible participants, 1309 (19%) tested positive for influenza virus, predominantly for A(H1N1)pdm09 (11%) and influenza B (7%). The effectiveness of the influenza vaccine against any influenza illness was 48% (95% confidence interval [CI], 41 to 55; P<0.001). Among children 2 to 17 years of age, the inactivated influenza vaccine was 60% effective (95% CI, 47 to 70; P<0.001), and the live attenuated vaccine was not observed to be effective (vaccine effectiveness, 5%; 95% CI, −47 to 39; P = 0.80). Vaccine effectiveness against A(H1N1)pdm09 among children was 63% (95% CI, 45 to 75; P<0.001) for the inactivated vaccine, as compared with −19% (95% CI, −113 to 33; P = 0.55) for the live attenuated vaccine. CONCLUSIONS Influenza vaccines reduced the risk of influenza illness in 2015–2016. However, the live attenuated vaccine was found to be ineffective among children in a year with substantial inactivated vaccine effectiveness. Because the 2016–2017 A(H1N1)pdm09 strain used in the live attenuated vaccine was unchanged from 2015–2016, the Advisory Committee on Immunization Practices made an interim recommendation not to use the live attenuated influenza vaccine for the 2016–2017 influenza season. (Funded by the Centers for Disease Control and Prevention and the National Institutes of Health.)

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“…All three test-negative studies carried out in the 2013-2014 influenza season in the USA reported low to negative and statistically non-significant vaccine effectiveness estimates for LAIV against any influenza strain and against A/H1N1pdm09. 58,59 In particular, in the study by Caspard et al, in which a total of 1,033 children and adolescents were included, influenza was detected in 14% of all children, with 74% of the influenza cases due to A/ H1N1pdm09 strains, 21% to influenza B, and 4% to influenza A/H3N2. LAIV did not show significant effectiveness against A/H1N1pdm09 (VE 13% [95% CI: ¡55 to 51]) but was effective against B/Yamagata strains (82% [95% CI: 12-96]).…”

Section: Live Attenuated Influenza Vaccine (Laiv) Effectivenessmentioning

confidence: 99%