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Seasonal Influenza Vaccination: Understanding Vaccine Effectiveness in Immunocompromised Adults

Kramer, Kailey L (2023) Seasonal Influenza Vaccination: Understanding Vaccine Effectiveness in Immunocompromised Adults. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Influenza 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.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Kramer, Kailey Lhugheskl@pitt.eduhugheskl
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairHaggerty, Catherine Lhaggertyc@edc.pitt.eduhaggerty
Committee MemberGoundappa, Balasubramanibkg10@pitt.edubkg10
Committee MemberRiddler, Sharon Ariddler@pitt.eduriddler
Committee MemberSilveira, Fernandafps2@pitt.edufps2
Committee MemberZimmerman, Richard Kzimmer@pitt.eduzimmer
Date: 3 January 2023
Date Type: Publication
Defense Date: 2 December 2022
Approval Date: 3 January 2023
Submission Date: 14 December 2022
Access Restriction: 1 year -- Restrict access to University of Pittsburgh for a period of 1 year.
Number of Pages: 81
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Epidemiology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: influenza, vaccine effectiveness, immunocompromised
Date Deposited: 03 Jan 2023 15:58
Last Modified: 03 Jan 2024 06:15


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