Reduced immunogenicity of BNT162b2 booster vaccination in combination with a tetravalent influenza vaccination: results of a prospective cohort study in 838 health workers

Radner, Helga; Sieghart, Daniela; Jorda, Anselm; Fedrizzi, Clemens; Hasenöhrl, Timothy; Zdravkovic, Andrej; Redlberger‐Fritz, Monika; Puchammer-Stoeckl, Elisabeth; Anderle, Karolina; Bergmann, Felix; Firbas, Christa; Jordakieva, Galateja; Wagner, Barbara; Haslacher, Helmuth; Perkmann, Thomas; Heinz, Leonhard X.; Bonelli, Michael; Crevenna, Richard; Aletaha, Daniel; Zeitlinger, Markus

doi:10.1016/j.cmi.2022.12.008

Cited by 14 publications

(13 citation statements)

References 11 publications

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“…Current literature has conflicting reports regarding immunogenicity of COVID-19 vaccines when administered together with SIV. Some studies reported a significant decrease in postvaccination titers 9,16 or reduced neutralization, 8 while others found that the humoral response was similar between coadministration and COVID-19 vaccination alone. 4,5 When looking into the current literature on the coadministration of these 2 vaccines, trials investigated the coadministration of several different types of COVID-19 vaccines.…”

Section: Discussionmentioning

confidence: 99%

Immunogenicity and Reactogenicity of Coadministration of COVID-19 and Influenza Vaccines

Gonen,

Barda,

Asraf

et al. 2023

JAMA Netw Open

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ImportanceCOVID-19 and seasonal influenza vaccines were previously given separately, although their coadministration is warranted for vaccination adherence. Limited data on their coadministration have been published.ObjectiveTo compare the reactogenicity and immunogenicity of COVID-19 and influenza vaccinations administered together with those of COVID-19 vaccination alone.Design, Setting, and ParticipantsThis prospective cohort study included health care workers at a large tertiary medical center in Israel who received the Influvac Tetra (Abbott) influenza vaccine (2022/2023), the Omicron BA.4/BA.5–adapted bivalent (Pfizer/BioNTech) vaccine, or both. Vaccination began in September 2022, and data were collected until January 2023. Vaccines were offered to all employees and were coadministered or given separately. Adverse reaction questionnaires were sent, and serologic samples were also collected.ExposuresReceiving COVID-19 vaccine, influenza vaccine, or both.Main Outcomes and MeasuresThe main outcomes for the reactogenicity analysis were symptoms following vaccine receipt, assessed by a digital questionnaire: any local symptoms; fever; weakness or fatigue; any systemic symptoms; and their duration. The immunogenicity analysis’ outcome was postvaccination anti-spike IgG titer.ResultsThis study included 2 cohorts for 2 separate analyses. The reactogenicity analysis included 588 participants (of 649 questionnaire responders): 85 in the COVID-19 vaccine–alone group (median [IQR] age, 71 [58-74] years; 56 [66%] female); 357 in the influenza vaccine–alone group (median [IQR] age, 55 [40-65] years; 282 [79%] female); and 146 in the coadministration group (median [IQR] age, 61 [50-71] years; 81 [55%] female). The immunogenicity analysis included 151 participants: 74 participants in the COVID-19 vaccine group (median [IQR] age, 67 [56-73] years; 45 [61%] female) and 77 participants in the coadministration group (median [IQR] age, 60 [49-73] years; 42 [55%] female). Compared with COVID-19 vaccination alone, the risk of systemic symptoms was similar in the coadministration group (odds ratio, 0.82; 95% CI, 0.43-1.56). Geometric mean titers in the coadministration group were estimated to be 0.84 (95% CI, 0.69-1.04) times lower than in the COVID-19 vaccine–alone group.Conclusions and RelevanceIn this cohort study of health care workers who received a COVID-19 vaccine, an influenza vaccine, or both, coadministration was not associated with substantially inferior immune response or to more frequent adverse events compared with COVID-19 vaccine administration alone, supporting the coadministration of these vaccines.

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Section: Discussionmentioning

confidence: 99%

Immunogenicity and Reactogenicity of Coadministration of COVID-19 and Influenza Vaccines

Gonen,

Barda,

Asraf

et al. 2023

JAMA Netw Open

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“…In addition, this also means that our main estimates primarily reflect the co-administration with the seasonal influenza vaccine. This is reassuring, since coadministration has been speculated to blunt the immune response, [14][15][16][17][18][19] and if that is the case, our estimates are likely conservative.…”

Section: Strengths and Limitations Of Studymentioning

confidence: 89%

Comparative effectiveness of the monovalent XBB.1.5-containing covid-19 mRNA vaccine across three Nordic countries

Andersson,

Thiesson,

Pihlström

et al. 2024

Preprint

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Objective: To estimate the effectiveness of vaccination with a monovalent XBB.1.5-containing covid-19 mRNA vaccine against severe covid-19 across three Nordic countries. Design: Nationwide cohort studies, using target trial emulation. Setting: Denmark, Finland, and Sweden, from 1 October 2023 to 29 February 2024. Participants: Individuals aged ≥65 years who had previously received at least four covid-19 vaccine doses. Main outcome measures: Cumulative incidences of covid-19 hospital admission and death for 12 weeks after immunisation (defined as 1 week after vaccination) among recipients of an XBB.1.5-containing covid-19 mRNA vaccine and matched non-recipients. Cumulative incidences were used to calculate comparative vaccine effectiveness (1-risk ratio) and risk differences. Results: During autumn and winter 2023-2024, a total of 1,867,448 1:1 matched pairs of XBB-containing covid-19 mRNA vaccine recipients and non-recipients were included (mean age 75.4 years, standard deviation 7.4 years). The comparative vaccine effectiveness was 60.6% (95% confidence interval, 46.1% to 75.1%) against covid-19 hospital admission (930 v 2,551 events) and 77.9% (69.2% to 86.7%) against covid-19 related death (301 v 1,326 events) at 12 weeks of follow-up. This corresponded to 191.1 (95% confidence interval, 50.2 to 332.1) covid-19 hospital admissions and 109.2 (100.2 to 118.1) deaths prevented per 100,000 individuals vaccinated with an XBB.1.5-containing vaccine. The comparative vaccine effectiveness was similar across sex, age (65-74/≥75 years), number of previous covid-19 vaccine doses received, and seasonal influenza vaccination co-administration subgroups and periods of either omicron XBB- or BA.2.86-sublineage dominance. While the protection was highest during the first weeks after vaccination, it was well-preserved at end of week 12 of follow-up. Conclusion: Among adults aged ≥65 years, vaccination with a monovalent XBB.1.5-containing covid-19 mRNA vaccine reduced the rates of covid-19 related hospital admission and death during autumn and winter 2023-2024 across three Nordic countries.

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“…In contrast, a large retrospective cohort study conducted in the United States targeting individuals aged 12 and older found an increased risk of systemic adverse reactions such as muscle pain with co‐administration of the seasonal influenza vaccine 30 . Reports on the potential for immunogenicity reduction with co‐administration of the influenza vaccine are mixed, with some suggesting no reduction and others suggesting a slight reduction in adults 31,32 . Currently, there are no reports specifically targeting young children receiving co‐administration of the influenza vaccine.…”

Section: Discussionmentioning

confidence: 99%

“…30 Reports on the potential for immunogenicity reduction with co-administration of the influenza vaccine are mixed, with some suggesting no reduction and others suggesting a slight reduction in adults. 31,32 Currently, there are no reports specifically targeting young children receiving co-administration of the influenza vaccine. Therefore, it is necessary to consider the benefits and risks of co-administration when determining the vaccination schedule, and further investigations are needed for young children.…”

Section: Respondents No (%)mentioning

confidence: 99%

Adverse reactions in young children receiving the coronavirus disease 2019 vaccine

Matsumoto,

Shimizu,

Yokoyama

et al. 2023

Pediatrics International

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BackgroundWe sought to investigate the occurrence of adverse reactions in Japanese children aged 6 months to 4 years who received the BNT162b2 coronavirus disease 2019 (COVID‐19) vaccine, to examine parental considerations, and to evaluate potential risk factors associated with post‐vaccination fever.MethodsThis cross‐sectional survey study targeted 1617 children aged 6 months to 4 years who received their primary doses of BNT162b2 from November 10, 2022, to April 30, 2023, in Okayama Prefecture. We surveyed the occurrence of local and systemic reactions within 1 week after vaccination, and described the incidence proportions of adverse reactions for 515 participants overall and by age group. The study also examined the impact of previous COVID‐19 infection and co‐administration of the seasonal influenza vaccine on post‐vaccination fever. A survey also assessed parents' reasons for vaccinating their children and the sources of information they used.ResultsAdverse reactions were infrequent (5.2%, with fever ≥37.5°C; no cases exceeded 39°C) and did not increase with vaccine doses administered. The risk of post‐vaccination fever was not statistically associated with a history of COVID‐19—the adjusted risk ratio (aRR) was 0.99, and the 95% confidence interval (CI) was 0.41–2.39—but was associated with co‐administration of the seasonal influenza vaccine (aRR 3.24, 95% CI 1.14–9.18). Parental decisions regarding vaccination were influenced by official government guidelines and primary care physicians' opinion.ConclusionThis study provides valuable insight into the safety profile of the BNT162b2 vaccine in Japanese children aged 6 months to 4 years. Further research involving larger cohorts and appropriate control groups is needed.

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Reduced immunogenicity of BNT162b2 booster vaccination in combination with a tetravalent influenza vaccination: results of a prospective cohort study in 838 health workers

Cited by 14 publications

References 11 publications

Immunogenicity and Reactogenicity of Coadministration of COVID-19 and Influenza Vaccines

Immunogenicity and Reactogenicity of Coadministration of COVID-19 and Influenza Vaccines

Comparative effectiveness of the monovalent XBB.1.5-containing covid-19 mRNA vaccine across three Nordic countries

Adverse reactions in young children receiving the coronavirus disease 2019 vaccine

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