Effectiveness of Adjuvanted Influenza Vaccination in Elderly Subjects in Northern Italy

• Published in: American journal of epidemiology Vol. 176; no. 6; pp. 527 - 533
• Main Authors: Mannino, S., Villa, M., Apolone, G., Weiss, N. S., Groth, N., Aquino, I., Boldori, L., Caramaschi, F., Gattinoni, A., Malchiodi, G., Rothman, K. J.
• Format: Journal Article
• Language: English
• Published: Cary, NC Oxford University Press 15.09.2012; Oxford Publishing Limited (England)
• Subjects: Adjuvants, Immunologic; Age Factors; Aged; Aged, 80 and over; Biological and medical sciences; Cohort Studies; Effectiveness; Epidemiology; Female; General aspects; Hospitalization; Hospitalization - statistics & numerical data; Human viral diseases; Humans; Immune response; Immunization; Infectious diseases; Influenza; Influenza Vaccines - chemistry; Influenza, Human - prevention & control; Italy; Logistic Models; Male; Medical sciences; Multivariate Analysis; Observational studies; Older people; Original Contributions; Pneumology; Pneumonia; Polysorbates; Prevention and actions; Propensity Score; Prospective Studies; Public health. Hygiene; Public health. Hygiene-occupational medicine; Respiratory system : syndromes and miscellaneous diseases; Squalene; Vaccines; Vaccines, Inactivated - chemistry; Viral diseases; Viral diseases of the respiratory system and ent viral diseases; Italy; Europe; Lombardy Italy; Human; Lung disease; Pneumonia; Respiratory disease; adjuvanted influenza vaccine; Vaccination; Vaccine; Epidemiology; Infection; Prevention; Immunoprophylaxis; Efficiency; Viral disease; Influenza; Adjuvant; North; Elderly; Public health
• DOI: 10.1093/aje/kws313
• ISSN: 0002-9262; 1476-6256

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.