Effectiveness of adjuvanted influenza vaccination in elderly subjects in northern Italy

Salvatore Mannino, Marco Villa, Giovanni Apolone, Noel S Weiss, Nicola Groth, Ivana Aquino, Liana Boldori, Fausta Caramaschi, Antonio Gattinoni, Giancarlo Malchiodi, Kenneth J Rothman, Salvatore Mannino, Marco Villa, Giovanni Apolone, Noel S Weiss, Nicola Groth, Ivana Aquino, Liana Boldori, Fausta Caramaschi, Antonio Gattinoni, Giancarlo Malchiodi, Kenneth J Rothman

Abstract

Although vaccination against influenza is recommended for elderly and high-risk patients in many countries, efficacy in the elderly has been suboptimal. The MF59 adjuvanted trivalent inactivated vaccine (ATIV) was developed to increase the immune response of elderly subjects to influenza vaccination, but its effectiveness has not yet been well documented. This prospective, observational study evaluated the relative effectiveness of ATIV versus nonadjuvanted trivalent inactivated vaccine (TIV) in individuals at least 65 years of age in Lombardy, northern Italy. Hospitalizations for influenza or pneumonia (International Classification of Diseases, Ninth Revision, Clinical Modification, codes 480-487) during the 2006-2007, 2007-2008, and 2008-2009 influenza seasons were identified from administrative databases. Stratified and regression analyses, including the propensity score to adjust for confounding, as well as generalized estimating equations to account for repeated vaccination, were used. Overall, 107,661 records were evaluated, contributing 170,988 person-seasons of observation. Since ATIV is preferentially recommended for more frail individuals, subjects vaccinated with ATIV were older and had more functional impairment and comorbidities. In the primary analysis, risk of hospitalization for influenza or pneumonia was 25% lower for ATIV relative to TIV (relative risk = 0.75, 95% confidence interval: 0.57, 0.98). To the extent that there is residual bias, ATIV is likely to be even more protective than this result suggests.

Figures

Figure 1.
Figure 1.
Time windows defined by the influenza incidence/1,000 person-weeks in Lombardy, Italy, 2006–2009. The intermediate time window includes adjacent weeks above the threshold of 0.5 case/1,000 person-weeks each year. Bars represent narrow time windows with a cumulative incidence of influenza rate of 1 case/1,000 person-weeks.

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