四价流感疫苗与三价流感疫苗：两个流感季节的临床结局，历史队列研究。

Quadrivalent versus trivalent influenza vaccine: clinical outcomes in two influenza seasons, historical cohort study.

机构信息

Meuhedet Health Services, Tel-Aviv, Israel; Infectious Diseases Unit, Tel-Aviv Sourasky Medical Centre, Tel-Aviv, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

Meuhedet Health Services, Tel-Aviv, Israel.

出版信息

Clin Microbiol Infect. 2020 Jan;26(1):101-106. doi: 10.1016/j.cmi.2019.05.003. Epub 2019 May 17.

DOI:10.1016/j.cmi.2019.05.003

PMID:31108229

Abstract

OBJECTIVES

The quadrivalent influenza vaccine (QIV) contains two influenza B antigens (one of each B lineage), while the trivalent vaccine (TIV) contains solely one. As a result, a mismatch between the circulating B lineage and the lineage in the TIV occurs frequently. We aimed to compare the frequency of clinically significant outcomes in a large cohort of vaccinees receiving either TIV or QIV.

METHODS

Historical cohort study of all inactivated influenza vaccinees (aged 3 years and older) in a Health Maintenance Organization insuring 1.2 million individuals, over two influenza seasons in which both vaccines were provided non-selectively. Primary outcome was hospital admissions during the influenza season. Multivariate analysis was performed using logistic regression to adjust for relevant covariates.

RESULTS

Our cohort included 150 518 and 168 296 vaccinees in the first (S1) and second season (S2), respectively. The two influenza seasons were characterized by high Influenza B activity. Of those vaccinated with QIV, 2074 of 49 726 (4.2%) and 6563 of 121 741 (5.4%) were hospitalized compared with 7378 of 100 792 (7.3%) and 3372 of 46 555 (7.2%) of those vaccinated with TIV (S1 and S2, respectively). After multivariate analysis adjusting for several covariates (gender, age, socioeconomic status, chronic morbidity, timing of vaccination), compared with TIV recipients, QIV vaccinees had lower odds for hospitalization (OR = 0.92, 95% CI 0.87-0.98 and OR = 0.89, 95% CI 0.85-0.93) or emergency department visit (OR = 0.91, 95% CI 0.87-0.95 and OR = 0.84, 95% CI 0.81-0.87) in S1 and S2, respectively (p < 0.001). Lower odds of mortality and influenza-like illness were also observed in S2 (OR = 0.61, 95% CI 0.50-0.75 and OR = 0.92, 95% CI 0.90-0.95, respectively).

CONCLUSIONS

In seasons with relatively high influenza B activity, QIV appeared more protective than TIV in Israel.

摘要

目的

四价流感疫苗（QIV）含有两种流感 B 型抗原（各有一个谱系），而三价疫苗（TIV）仅含有一种。因此，TIV 中流行的谱系与实际流行的 B 谱系经常不匹配。我们旨在比较在接受 TIV 或 QIV 的大量疫苗接种者中，具有临床意义的结果的频率。

方法

这是一项历史队列研究，纳入了医疗保险机构中所有接种灭活流感疫苗的人群（年龄≥3 岁），该医疗保险机构承保了 120 万人，在两个流感季节中，两种疫苗均非选择性提供。主要结局为流感季节的住院治疗。采用 logistic 回归进行多变量分析，以调整相关协变量。

结果

在第一个（S1）和第二个季节（S2）中，我们的队列分别纳入了 150518 名和 168296 名疫苗接种者。这两个流感季节均以高乙型流感活动度为特征。在接种 QIV 的人群中，与接种 TIV 的人群相比，49726 人中分别有 2074 人（4.2%）和 121741 人中分别有 6563 人（5.4%）住院，而在接种 TIV 的人群中，100792 人中分别有 7378 人（7.3%）和 46555 人中分别有 3372 人（7.2%）住院（S1 和 S2 分别如此）。经多变量分析调整了性别、年龄、社会经济状况、慢性疾病、疫苗接种时间等几个协变量后，与 TIV 组相比，QIV 疫苗接种者的住院（OR=0.92，95%CI 0.87-0.98 和 OR=0.89，95%CI 0.85-0.93）或急诊就诊（OR=0.91，95%CI 0.87-0.95 和 OR=0.84，95%CI 0.81-0.87）的几率较低，S1 和 S2 分别如此（p<0.001）。在 S2 中，死亡率和流感样疾病的几率也较低（OR=0.61，95%CI 0.50-0.75 和 OR=0.92，95%CI 0.90-0.95，分别如此）。