Prevention of Antigenically Drifted Influenza by Inactivated and Live Attenuated Vaccines
Suzanne E. Ohmit, Dr.P.H., John C. Victor, Ph.D., M.P.H., Judy R. Rotthoff, R.N., Esther R. Teich, M.A., Rachel K. Truscon, M.P.H., Laura L. Baum, M.S., Bhavya Rangarajan, M.P.H., Duane W. Newton, Ph.D., Matthew L. Boulton, M.D., M.P.H., and Arnold S. Monto, M.D.
Background The efficacy of influenza vaccines may decline duringyears when the circulating viruses have antigenically driftedfrom those included in the vaccine.
Methods We carried out a randomized, double-blind, placebo-controlledtrial of inactivated and live attenuated influenza vaccinesin healthy adults during the 2004–2005 influenza seasonand estimated both absolute and relative efficacies.
Results A total of 1247 persons were vaccinated between Octoberand December 2004. Influenza activity in Michigan began in January2005 with the circulation of an antigenically drifted type A(H3N2) virus, the A/California/07/2004-like strain, and of typeB viruses from two lineages. The absolute efficacy of the inactivatedvaccine against both types of virus was 77% (95% confidenceinterval [CI], 37 to 92) as measured by isolating the virusin cell culture, 75% (95% CI, 42 to 90) as measured by eitherisolating the virus in cell culture or identifying it throughreal-time polymerase chain reaction, and 67% (95% CI, 16 to87) as measured by either isolating the virus or observing arise in the serum antibody titer. The absolute efficacies ofthe live attenuated vaccine were 57% (95% CI, –3 to 82),48% (95% CI, –7 to 74), and 30% (95% CI, –57 to67), respectively. The difference in efficacy between the twovaccines appeared to be related mainly to reduced protectionof the live attenuated vaccine against type B viruses.
Conclusions In the 2004–2005 season, in which most circulatingviruses were dissimilar to those included in the vaccine, theinactivated vaccine was efficacious in preventing laboratory-confirmedsymptomatic illnesses from influenza in healthy adults. Thelive attenuated vaccine also prevented influenza illnesses butwas less efficacious. (ClinicalTrials.gov number, NCT00133523
[ClinicalTrials.gov]
.)
Source Information
From the Department of Epidemiology, University of Michigan School of Public Health (S.E.O., J.C.V., J.R.R., E.R.T., R.K.T., L.L.B., B.R., D.W.N., M.L.B., A.S.M.); and the Department of Pathology–Virology, University of Michigan Hospitals (D.W.N.) — both in Ann Arbor.
Address reprint requests to Dr. Ohmit at the University of Michigan School of Public Health, 109 Observatory St., Ann Arbor, MI 48109, or at sohmit{at}umich.edu.
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