2022-2023 年度流感季≥65 岁老年人中 licensed 流感疫苗预防流感相关医疗就诊和住院的效果比较。

Comparative Effectiveness of Licensed Influenza Vaccines in Preventing Influenza-related Medical Encounters and Hospitalizations in the 2022-2023 Influenza Season Among Adults ≥65 Years of Age.

机构信息

Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA.

Moderna Inc., Cambridge, Massachusetts, USA.

出版信息

Clin Infect Dis. 2024 Nov 22;79(5):1283-1292. doi: 10.1093/cid/ciae375.

DOI:10.1093/cid/ciae375

PMID:39166857

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11581696/

Abstract

BACKGROUND

Influenza causes substantial morbidity, particularly among older individuals. Updated data on the effectiveness of currently licensed vaccines in this population are needed.

METHODS

At Kaiser Permanente Southern California, we conducted a retrospective cohort study to evaluate comparative vaccine effectiveness (cVE) of high-dose (HD), adjuvanted, and standard-dose (SD) cell-based influenza vaccines, relative to the SD egg-based vaccine. We included adults aged ≥65 years who received an influenza vaccine between 1 August 2022 and 31 December 2022, with follow-up up to 20 May 2023. Primary outcomes were: (1) influenza-related medical encounters and (2) polymerase chain reaction (PCR)-confirmed influenza-related hospitalization. Adjusted hazard ratios (aHR) were estimated by Cox proportional hazards regression, adjusting for confounders using inverse probability of treatment weighting (IPTW). cVE (%) was calculated as (1-aHR) × 100 when aHR ≤1, and ([1/aHR]-1) × 100 when aHR >1.

RESULTS

Our study population (n = 495 119) was 54.9% female, 46.3% non-Hispanic White, with a median age of 73 years (interquartile range [IQR] 69-79). Characteristics of all groups were well balanced after IPTW. Adjusted cVEs against influenza-related medical encounters in the HD, adjuvanted, and SD cell-based vaccine groups were 9.1% (95% confidence interval [CI]: .9, 16.7), 16.9% (95% CI: 1.7, 29.8), and -6.3 (95% CI: -18.3, 6.9), respectively. Adjusted cVEs against PCR-confirmed hospitalization in the HD, adjuvanted, and SD cell-based groups were 25.1% (95% CI: .2, 43.8), 61.6% (95% CI: 18.1, 82.0), and 26.4% (95% CI: -18.3, 55.7), respectively.

CONCLUSIONS

Compared to the SD egg-based vaccine, HD and adjuvanted vaccines conferred additional protection against influenza-related outcomes in the 2022-2023 season in adults ≥65 years. Our results provide real-world evidence of the comparative effectiveness of currently licensed vaccines.

摘要

背景

流感会导致大量发病，尤其是在老年人中。需要更新有关当前许可疫苗在该人群中有效性的数据。

方法

在凯撒永久南加州，我们进行了一项回顾性队列研究，以评估高剂量（HD）、佐剂和标准剂量（SD）细胞流感疫苗与 SD 卵基疫苗相比的疫苗相对有效性（cVE）。我们纳入了 2022 年 8 月 1 日至 2022 年 12 月 31 日期间接受流感疫苗接种、随访至 2023 年 5 月 20 日且年龄≥65 岁的成年人。主要结局是：（1）流感相关医疗就诊和（2）聚合酶链反应（PCR）确诊的流感相关住院。使用逆概率治疗加权（IPTW）调整协变量后，通过 Cox 比例风险回归估计调整后危险比（aHR）。当 aHR≤1 时，cVE（%）计算为（1-aHR）×100；当 aHR>1 时，计算为([1/aHR]-1)×100。

结果

我们的研究人群（n=495119）中，54.9%为女性，46.3%为非西班牙裔白人，中位年龄为 73 岁（四分位距[IQR]69-79）。经 IPTW 后，所有组的特征均得到很好的平衡。HD、佐剂和 SD 细胞疫苗组中针对流感相关医疗就诊的调整后 cVE 分别为 9.1%（95%置信区间[CI]：.9，16.7）、16.9%（95% CI：1.7，29.8）和-6.3（95% CI：-18.3，6.9）。HD、佐剂和 SD 细胞疫苗组中针对 PCR 确诊住院的调整后 cVE 分别为 25.1%（95% CI：.2，43.8）、61.6%（95% CI：18.1，82.0）和 26.4%（95% CI：-18.3，55.7）。