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Relative vaccine effectiveness of high-dose versus standard-dose influenza vaccines among veterans health administration patients
Young-Xu, Y., Van Aalst, R., Mahmud, S. M., Rothman, K. J., Thornton Snider, J., Westreich, D., Mor, V., Gravenstein, S., Lee, J. K. H., Thommes, E. W., Decker, M. D., & Chit, A. (2018). Relative vaccine effectiveness of high-dose versus standard-dose influenza vaccines among veterans health administration patients. Journal of Infectious Diseases, 217(11), 1718-1727. https://doi.org/10.1093/infdis/jiy088
Background. We examined whether a high-dose inactivated influenza vaccine was more efficacious in preventing hospitalizations than a standard-dose vaccine in the Veterans Health Administration (VHA) senior population.
Methods. This study estimated the relative vaccine effectiveness (rVE) of high dose versus standard dose using a retrospective cohort of VHA patients 65 years of age or older in the 2015-2016 influenza season. To adjust for measured confounders, we matched each high-dose recipient with up to 4 standard-dose recipients vaccinated at the same location within a 2-week period and having 2 or more pre-existing medical comorbidities. We used the previous event rate ratio method (PERR), a type of difference-in-differences analysis, to adjust for unmeasured confounders.
Results. We evaluated 104 965 standard-dose and 125 776 high-dose recipients; matching decreased the population to 49 091 standard-dose and 24 682 high-dose recipients. The matched, PERR-adjusted rVE was 25% (95% confidence interval [CI], 2%-43%) against influenza-or pneumonia-associated hospitalization, 7% (95% CI, -2% to 14%) against all-cause hospitalization, 14% (95% CI, -8% to 32%) against influenza-or pneumonia-associated outpatient visit, 5% (95% CI, 2%-8%) against all-cause outpatient visit, and 38% (95% CI, -5% to 65%) against laboratory-confirmed influenza.
Conclusions. In protecting senior VHA patients against influenza-or pneumonia-associated hospitalization, a high-dose influenza vaccine is more effective than a standard-dose vaccine.
