Seasonal Influenza Vaccination: Understanding Vaccine Effectiveness in Immunocompromised AdultsKramer, Kailey L (2023) Seasonal Influenza Vaccination: Understanding Vaccine Effectiveness in Immunocompromised Adults. Doctoral Dissertation, University of Pittsburgh. (Unpublished)
AbstractInfluenza vaccine effectiveness (VE) among immunocompromised (IC) adults is severely under-researched despite the large and increasing magnitude of this demographic group. Current IC adult influenza vaccine research is limited to vaccine immunogenicity and efficacy studies with small sample sizes, leaving substantial gaps in our understanding of influenza VE among IC adults. Our long-term objective is to understand the VE of influenza vaccines among IC adults to guide clinical decision making, decrease influenza-related hospitalizations, and improve influenza outcomes. Using the Centers for Disease Control and Prevention datasets- Hospitalized Adult Influenza Vaccine Effectiveness Network (HAIVEN) and the U.S. Flu Vaccine Effectiveness Network (US FluVE)- from the 2017-2018 influenza season, we calculated and compared VE for inpatient and outpatient adults >18 years with and without immunocompromising conditions. The HAIVEN 2018-2019 dataset was used to determine the VE of the recombinant seasonal influenza vaccine compared to non-recombinant seasonal influenza vaccines in IC adults. Of the 3524 adults enrolled in HAIVEN 2017-2018, 1210 (34.3%) had an IC condition. VE was 5% (95% CI, –29% to 31%) vs. 41% (95% CI, 27–52) among IC and non-IC adults, respectively. Of the 8900 individuals enrolled in US FluVE 2017-2018, 455 (8%) of the 5671 adults had an IC condition. VE was -5 (95% CI: -68, 34) among IC adults and 29 (95% CI: 20, 37) among non-IC adults. Finally, of the 3975 individuals enrolled in the HAIVEN 2018-2019 study, 952 (24%) individuals were classified as IC. VE for the recombinant and non-recombinant seasonal influenza vaccine was 39% (95% CI: -23, 70) and 10% (95% CI: -37, 41), respectively. The results of our studies offer insight into the protection provided by influenza vaccines to IC adults. Understanding the effectiveness of the influenza vaccines will allow providers to suggest additional infection prevention measures such as increased masking during the influenza season, delayed vaccination, or potentially booster shots. By standardizing the definition of immunocompromised using ICD-10 and CPT codes, our research can be replicated in future influenza seasons and influenza vaccine studies. Preventing influenza infections in immunocompromised adults is critical for protecting this vulnerable population. Share
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