Vaccine failure and serologic response to live attenuated and inactivated influenza vaccines in children during the 2013–2014 season. Issue 9 (21st February 2018)

• Record Type: Journal Article
• Authors: King, Jennifer P.; McLean, Huong Q.; Meece, Jennifer K.; Levine, Min Z.; Spencer, Sarah M.; Flannery, Brendan; Belongia, Edward A.
• Is Part Of: Vaccine. Volume 36:Issue 9(2018)
• Page Start: 1214
• Page End: 1219
• Publication Date: 2018-02-21
• Subjects: LAIV live attenuated influenza vaccine -- IIV inactivated Influenza Vaccine -- ACIP Advisory Committee on Immunization Practices -- HI hemagglutination inhibition -- RT-PCR Reverse Transcription Polymerase Chain Reaction -- CDC Centers for Disease Control and Prevention -- GMT geometric mean titer -- GMFR geometric mean fold rise -- SD standard deviation; Children -- Hemagglutination inhibition -- Immune response -- Influenza vaccine; Vaccines -- Periodicals; 615.372
• DOI: 10.1016/j.vaccine.2018.01.016
• Languages: English
• ISSNs: 0264-410X

Abstract

Highlights: Serologic responses to LAIV4 and IIV3 were compared in 5–17 year olds in 2013–2014. LAIV4 elicited minimal HI antibody response, including in seronegative children. Titers against vaccine strains increased from baseline 1.0 to 3.3 times for IIV. LAIV receipt was associated with vaccine failure after adjusting for age. Abstract: Background: Recent observational studies in the United States indicated live attenuated influenza vaccine (LAIV) was less effective in children against clinical influenza infection caused by A(H1N1)pdm09 relative to inactivated influenza vaccine (IIV). During the 2013–2014 influenza season, we conducted an observational study among children aged 5–17 years to compare serologic responses to LAIV and IIV and explore factors associated with vaccine failure. Methods: One hundred and sixty-one children received one dose of trivalent IIV or quadrivalent LAIV according to parental preference. Baseline and postvaccination serum samples were tested with hemagglutination inhibition (HI) assays against vaccine reference strains. Geometric mean titers (GMT), geometric mean fold rise (GMFR), seroconversion, and seroprotection (HI titer ≥ 40) were used to assess response to vaccine. Active surveillance for acute respiratory illness was conducted during the influenza season and influenza cases were confirmed by reverse transcription polymerase chain reaction (RT-PCR). Logistic regression was used to examine the association between vaccine type and vaccine failure. Results: LAIV and IIV recipients were similar with respect to demographics and baseline GMT for each vaccine strain. RT-PCR confirmed influenza (vaccine failure) occurred in 8 (13%) of 62 LAIV recipients and 3 (3%) of 99 IIV recipients (p = .02). Postvaccination GMFR for A(H1N1)pdm09 was higher for IIV vs LAIV receipt (GMFR 3.3 vs. 0.8, p < .0001). Postvaccination titers against A(H1N1)pdm09 were ≥40 for 91% and 44% of IIV and LAIV recipients, respectively (p < .0001). Among 13 IIV and 18 LAIV recipients with seronegative baseline titer against A(H1N1pdm09), 54% and 0% seroconverted, respectively. LAIV receipt was the only factor associated with A(H1N1)pdm09 vaccine failure in the age-adjusted multivariable model (odds ratio 4.5, 95% CI 1.1–18.2). Conclusion: Receipt of LAIV generated minimal HI antibody response in children, including among those seronegative at baseline. LAIV recipients had significant increased risk of A(H1N1)pdm09 infection compared to IIV recipients.