Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, Texas, USA.
Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA.
Clin Infect Dis. 2021 Apr 8;72(7):1147-1157. doi: 10.1093/cid/ciaa102.
Since 2013, quadrivalent influenza vaccines containing 2 B viruses gradually replaced trivalent vaccines in the United States. We compared the vaccine effectiveness of quadrivalent to trivalent inactivated vaccines (IIV4 to IIV3, respectively) against illness due to influenza B during the transition, when IIV4 use increased rapidly.
The US Influenza Vaccine Effectiveness (Flu VE) Network analyzed 25 019 of 42 600 outpatients aged ≥6 months who enrolled within 7 days of illness onset during 6 seasons from 2011-2012. Upper respiratory specimens were tested for the influenza virus type and B lineage. Using logistic regression, we estimated IIV4 or IIV3 effectiveness by comparing the odds of an influenza B infection overall and the odds of B lineage among vaccinated versus unvaccinated participants. Over 4 seasons from 2013-2014, we compared the relative odds of an influenza B infection among IIV4 versus IIV3 recipients.
Trivalent vaccines included the predominantly circulating B lineage in 4 of 6 seasons. During 4 influenza seasons when both IIV4 and IIV3 were widely used, the overall effectiveness against any influenza B was 53% (95% confidence interval [CI], 45-59) for IIV4 versus 45% (95% CI, 34-54) for IIV3. IIV4 was more effective than IIV3 against the B lineage not included in IIV3, but comparative effectiveness against illnesses related to any influenza B favored neither vaccine valency.
The uptake of quadrivalent inactivated influenza vaccines was not associated with increased protection against any influenza B illness, despite the higher effectiveness of quadrivalent vaccines against the added B virus lineage. Public health impact and cost-benefit analyses are needed globally.
自 2013 年以来，含 2 种 B 型病毒的四价流感疫苗逐渐取代了美国的三价疫苗。在四价疫苗（IIV4）快速普及的背景下，我们比较了 IIV4 和 IIV3（分别为四价和三价流感灭活疫苗）在流感 B 型疾病方面的疫苗效果。
美国流感疫苗有效性（Flu VE）网络分析了 2011-2012 年六个季节期间 42600 名 6 个月以上门诊患者中的 25019 例，这些患者在发病后 7 天内入组。上呼吸道标本进行流感病毒类型和 B 谱系检测。采用逻辑回归，我们通过比较接种组与未接种组中流感 B 感染的总体可能性以及 B 谱系的可能性，估计了 IIV4 或 IIV3 的效果。在 2013-2014 年的四个季节中，我们比较了 IIV4 与 IIV3 受种者中 B 谱系流感感染的相对可能性。
四价疫苗在六个季节中的四个季节中包含了主要流行的 B 谱系。在四价和三价疫苗广泛使用的四个流感季节中，任何流感 B 型的总体有效性为 IIV4 53%（95%置信区间[CI]，45-59），而 IIV3 为 45%（95% CI，34-54）。IIV4 对 IIV3 未包含的 B 谱系更有效，但对任何流感 B 型相关疾病的相对有效性都不支持两种疫苗的效价。
尽管四价流感疫苗对添加的 B 型病毒谱系更有效，但四价灭活流感疫苗的接种并未增加对任何流感 B 型疾病的保护作用。需要在全球范围内进行公共卫生影响和成本效益分析。
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