Effectiveness and cost-benefit of influenza vaccination of healthy working adults: a randomized controlled trial
TL;DR: Influenza vaccination of healthy working adults younger than 65 years can reduce the rates of ILI, lost workdays, and physician visits during years when the vaccine and circulating viruses are similar, but vaccination may not provide overall economic benefits in most years.
Abstract: ContextAlthough the cost-effectiveness and cost-benefit of influenza vaccination
are well established for persons aged 65 years or older, the benefits for
healthy adults younger than 65 years are less clear.ObjectiveTo evaluate the effectiveness and cost-benefit of influenza vaccine
in preventing influenzalike illness (ILI) and reducing societal costs of ILI
among healthy working adults.DesignDouble-blind, randomized, placebo-controlled trial conducted during
2 influenza seasons.Setting and ParticipantsHealthy adults aged 18 to 64 years and employed full-time by a US manufacturing
company (for 1997-1998 season, n = 1184; for 1998-1999 season, n = 1191).InterventionsFor each season, participants were randomly assigned to receive either
trivalent inactivated influenza vaccine (n = 595 in 1997-1998 and n = 587
in 1998-1999) or sterile saline injection (placebo; n = 589 in 1997-1998 and
n = 604 in 1998-1999). Participants in 1997-1998 were rerandomized if they
participated in 1998-1999.Main Outcome MeasuresInfluenzalike illnesses and associated physician visits and work absenteeism
reported in biweekly questionnaires by all participants, and serologically
confirmed influenza illness among 23% of participants in each year (n = 275
in 1997-1998; n = 278 in 1998-1999); societal cost of ILI per vaccinated vs
unvaccinated person.ResultsFor 1997-1998 and 1998-1999, respectively, 95% (1130/1184) and 99% (1178/1191)
of participants had complete follow-up, and 23% in each year had serologic
testing. In 1997-1998, when the vaccine virus differed from the predominant
circulating viruses, vaccine efficacy against serologically confirmed influenza
illness was 50% (P = .33). In this season, vaccination
did not reduce ILI, physician visits, or lost workdays; the net societal cost
was $65.59 per person compared with no vaccination. In 1998-1999, the vaccine
and predominant circulating viruses were well matched. Vaccine efficacy was
86% (P = .001), and vaccination reduced ILI, physician
visits, and lost workdays by 34%, 42%, and 32%, respectively. However, vaccination
resulted in a net societal cost of $11.17 per person compared with no vaccination.ConclusionInfluenza vaccination of healthy working adults younger than 65 years
can reduce the rates of ILI, lost workdays, and physician visits during years
when the vaccine and circulating viruses are similar, but vaccination may
not provide overall economic benefits in most years.
Citations
More filters
Journal Article•
TL;DR: This report updates the 2000 recommendations by the Advisory Committee on Immunization Practices on the use of influenza vaccine and antiviral agents with new or updated information regarding the cost-effectiveness of influenza vaccination and the 2001-2002 trivalent vaccine virus strains.
Abstract: This report updates the 2002 recommendations by the Advisory Committee on Immunization Practices (ACIP) on the use of influenza vaccine and antiviral agents (CDC. Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2002;51 [No. RR-3]:1-31). The 2003 recommendations include new or updated information regarding 1) the timing of influenza vaccination by age and risk group; 2) influenza vaccine for children aged 6-23 months; 3) the 2003-2004 trivalent inactivated vaccine virus strains: A/Moscow/10/99 (H3N2)-like, A/New Caledonia/20/99 (H1N1)-like, and B/Hong Kong/330/2001-like antigens (for the A/Moscow/10/99 [H3N2]-like antigen, manufacturers will use the antigenically equivalent A/Panama/2007/99 [H3N2] virus, and for the B/Hong Kong/330/2001-like antigen, manufacturers will use either B/Hong Kong/330/2001 or the antigenically equivalent B/Hong Kong/1434/2002); 4) availability of certain influenza vaccine doses with reduced thimerosal content, including single 0.25 mL-dose syringes; and 5) manufacturers of influenza vaccine for the U.S. market. Although the optimal time to vaccinate against influenza is October and November, vaccination in December and later continues to be strongly recommended A link to this report and other information regarding influenza can be accessed at http://www.cdc.gov/ncidod/diseases/flu/fluvirus.htm.
5,334 citations
TL;DR: The results highlight the enormous annual burden of influenza in the US, with hospitalization costs and lost productivity from missed work days and lost lives comprise the bulk of the economic burden.
1,667 citations
Journal Article•
TL;DR: This report updates the 2008 recommendations by CDC's Advisory Committee on Immunization Practices regarding the use of influenza vaccine for the prevention and control of seasonal influenza and includes a summary of safety data for U.S. licensed influenza vaccines.
Abstract: This report updates the 2009 recommendations by CDC's Advisory Committee on Immunization Practices (ACIP) regarding the use of influenza vaccine for the prevention and control of influenza (CDC. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2009;58[No. RR-8] and CDC. Use of influenza A (H1N1) 2009 monovalent vaccine---recommendations of the Advisory Committee on Immunization Practices [ACIP], 2009. MMWR 2009;58:[No. RR-10]). The 2010 influenza recommendations include new and updated information. Highlights of the 2010 recommendations include 1) a recommendation that annual vaccination be administered to all persons aged >or=6 months for the 2010-11 influenza season; 2) a recommendation that children aged 6 months--8 years whose vaccination status is unknown or who have never received seasonal influenza vaccine before (or who received seasonal vaccine for the first time in 2009-10 but received only 1 dose in their first year of vaccination) as well as children who did not receive at least 1 dose of an influenza A (H1N1) 2009 monovalent vaccine regardless of previous influenza vaccine history should receive 2 doses of a 2010-11 seasonal influenza vaccine (minimum interval: 4 weeks) during the 2010--11 season; 3) a recommendation that vaccines containing the 2010-11 trivalent vaccine virus strains A/California/7/2009 (H1N1)-like (the same strain as was used for 2009 H1N1 monovalent vaccines), A/Perth/16/2009 (H3N2)-like, and B/Brisbane/60/2008-like antigens be used; 4) information about Fluzone High-Dose, a newly approved vaccine for persons aged >or=65 years; and 5) information about other standard-dose newly approved influenza vaccines and previously approved vaccines with expanded age indications. Vaccination efforts should begin as soon as the 2010-11 seasonal influenza vaccine is available and continue through the influenza season. These recommendations also include a summary of safety data for U.S.-licensed influenza vaccines. These recommendations and other information are available at CDC's influenza website (http://www.cdc.gov/flu); any updates or supplements that might be required during the 2010-11 influenza season also will be available at this website. Recommendations for influenza diagnosis and antiviral use will be published before the start of the 2010-11 influenza season. Vaccination and health-care providers should be alert to announcements of recommendation updates and should check the CDC influenza website periodically for additional information.
1,659 citations
Cites background from "Effectiveness and cost-benefit of i..."
...However, even during years when vaccine strains were not antigenically well matched to circulating strains (the result of antigenic drift), substantial protection has been observed against severe outcomes, presumably because of vaccine-induced cross-reacting antibodies (121,125,222,283)....
[...]
...effectiveness sometimes are observed compared with seasons when vaccine and circulating strains are well-matched,(107,121,125,173,222)....
[...]
TL;DR: Analysis of neutralization by the full complement of anti-HIV broadly neutralizing monoclonal antibodies now available reveals that certain combinations of antibodies should offer markedly more favourable coverage of the enormous diversity of global circulating viruses than others and these combinations might be sought in active or passive immunization regimes.
Abstract: Broadly neutralizing antibodies against highly variable viral pathogens are much sought after to treat or protect against global circulating viruses. Here we probed the neutralizing antibody repertoires of four human immunodeficiency virus (HIV)-infected donors with remarkably broad and potent neutralizing responses and rescued 17 new monoclonal antibodies that neutralize broadly across clades. Many of the new monoclonal antibodies are almost tenfold more potent than the recently described PG9, PG16 and VRC01 broadly neutralizing monoclonal antibodies and 100-fold more potent than the original prototype HIV broadly neutralizing monoclonal antibodies. The monoclonal antibodies largely recapitulate the neutralization breadth found in the corresponding donor serum and many recognize novel epitopes on envelope (Env) glycoprotein gp120, illuminating new targets for vaccine design. Analysis of neutralization by the full complement of anti-HIV broadly neutralizing monoclonal antibodies now available reveals that certain combinations of antibodies should offer markedly more favourable coverage of the enormous diversity of global circulating viruses than others and these combinations might be sought in active or passive immunization regimes. Overall, the isolation of multiple HIV broadly neutralizing monoclonal antibodies from several donors that, in aggregate, provide broad coverage at low concentrations is a highly positive indicator for the eventual design of an effective antibody-based HIV vaccine.
1,473 citations
TL;DR: This report updates the 2017–18 recommendations of the Advisory Committee on Immunization Practices regarding the use of seasonal influenza vaccines in the United States and focuses on the recommendations for use of vaccines for the prevention and control of influenza during the 2018–19 season.
Abstract: This report updates the 2020-21 recommendations of the Advisory Committee on Immunization Practices (ACIP) regarding the use of seasonal influenza vaccines in the United States (MMWR Recomm Rep 2020;69[No. RR-8]). Routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications. For each recipient, a licensed and age-appropriate vaccine should be used. ACIP makes no preferential recommendation for a specific vaccine when more than one licensed, recommended, and age-appropriate vaccine is available. During the 2021-22 influenza season, the following types of vaccines are expected to be available: inactivated influenza vaccines (IIV4s), recombinant influenza vaccine (RIV4), and live attenuated influenza vaccine (LAIV4).The 2021-22 influenza season is expected to coincide with continued circulation of SARS-CoV-2, the virus that causes COVID-19. Influenza vaccination of persons aged ≥6 months to reduce prevalence of illness caused by influenza will reduce symptoms that might be confused with those of COVID-19. Prevention of and reduction in the severity of influenza illness and reduction of outpatient visits, hospitalizations, and intensive care unit admissions through influenza vaccination also could alleviate stress on the U.S. health care system. Guidance for vaccine planning during the pandemic is available at https://www.cdc.gov/vaccines/pandemic-guidance/index.html. Recommendations for the use of COVID-19 vaccines are available at https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/covid-19.html, and additional clinical guidance is available at https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html.Updates described in this report reflect discussions during public meetings of ACIP that were held on October 28, 2020; February 25, 2021; and June 24, 2021. Primary updates to this report include the following six items. First, all seasonal influenza vaccines available in the United States for the 2021-22 season are expected to be quadrivalent. Second, the composition of 2021-22 U.S. influenza vaccines includes updates to the influenza A(H1N1)pdm09 and influenza A(H3N2) components. U.S.-licensed influenza vaccines will contain hemagglutinin derived from an influenza A/Victoria/2570/2019 (H1N1)pdm09-like virus (for egg-based vaccines) or an influenza A/Wisconsin/588/2019 (H1N1)pdm09-like virus (for cell culture-based and recombinant vaccines), an influenza A/Cambodia/e0826360/2020 (H3N2)-like virus, an influenza B/Washington/02/2019 (Victoria lineage)-like virus, and an influenza B/Phuket/3073/2013 (Yamagata lineage)-like virus. Third, the approved age indication for the cell culture-based inactivated influenza vaccine, Flucelvax Quadrivalent (ccIIV4), has been expanded from ages ≥4 years to ages ≥2 years. Fourth, discussion of administration of influenza vaccines with other vaccines includes considerations for coadministration of influenza vaccines and COVID-19 vaccines. Providers should also consult current ACIP COVID-19 vaccine recommendations and CDC guidance concerning coadministration of these vaccines with influenza vaccines. Vaccines that are given at the same time should be administered in separate anatomic sites. Fifth, guidance concerning timing of influenza vaccination now states that vaccination soon after vaccine becomes available can be considered for pregnant women in the third trimester. As previously recommended, children who need 2 doses (children aged 6 months through 8 years who have never received influenza vaccine or who have not previously received a lifetime total of ≥2 doses) should receive their first dose as soon as possible after vaccine becomes available to allow the second dose (which must be administered ≥4 weeks later) to be received by the end of October. For nonpregnant adults, vaccination in July and August should be avoided unless there is concern that later vaccination might not be possible. Sixth, contraindications and precautions to the use of ccIIV4 and RIV4 have been modified, specifically with regard to persons with a history of severe allergic reaction (e.g., anaphylaxis) to an influenza vaccine. A history of a severe allergic reaction to a previous dose of any egg-based IIV, LAIV, or RIV of any valency is a precaution to use of ccIIV4. A history of a severe allergic reaction to a previous dose of any egg-based IIV, ccIIV, or LAIV of any valency is a precaution to use of RIV4. Use of ccIIV4 and RIV4 in such instances should occur in an inpatient or outpatient medical setting under supervision of a provider who can recognize and manage a severe allergic reaction; providers can also consider consulting with an allergist to help identify the vaccine component responsible for the reaction. For ccIIV4, history of a severe allergic reaction (e.g., anaphylaxis) to any ccIIV of any valency or any component of ccIIV4 is a contraindication to future use of ccIIV4. For RIV4, history of a severe allergic reaction (e.g., anaphylaxis) to any RIV of any valency or any component of RIV4 is a contraindication to future use of RIV4. This report focuses on recommendations for the use of vaccines for the prevention and control of seasonal influenza during the 2021-22 influenza season in the United States. A brief summary of the recommendations and a link to the most recent Background Document containing additional information are available at https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/flu.html. These recommendations apply to U.S.-licensed influenza vaccines used according to Food and Drug Administration-licensed indications. Updates and other information are available from CDC's influenza website (https://www.cdc.gov/flu); vaccination and health care providers should check this site periodically for additional information.
1,388 citations
References
More filters
Journal Article•
TL;DR: This report updates the 2000 recommendations by the Advisory Committee on Immunization Practices on the use of influenza vaccine and antiviral agents with new or updated information regarding the cost-effectiveness of influenza vaccination and the 2001-2002 trivalent vaccine virus strains.
Abstract: This report updates the 2002 recommendations by the Advisory Committee on Immunization Practices (ACIP) on the use of influenza vaccine and antiviral agents (CDC. Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2002;51 [No. RR-3]:1-31). The 2003 recommendations include new or updated information regarding 1) the timing of influenza vaccination by age and risk group; 2) influenza vaccine for children aged 6-23 months; 3) the 2003-2004 trivalent inactivated vaccine virus strains: A/Moscow/10/99 (H3N2)-like, A/New Caledonia/20/99 (H1N1)-like, and B/Hong Kong/330/2001-like antigens (for the A/Moscow/10/99 [H3N2]-like antigen, manufacturers will use the antigenically equivalent A/Panama/2007/99 [H3N2] virus, and for the B/Hong Kong/330/2001-like antigen, manufacturers will use either B/Hong Kong/330/2001 or the antigenically equivalent B/Hong Kong/1434/2002); 4) availability of certain influenza vaccine doses with reduced thimerosal content, including single 0.25 mL-dose syringes; and 5) manufacturers of influenza vaccine for the U.S. market. Although the optimal time to vaccinate against influenza is October and November, vaccination in December and later continues to be strongly recommended A link to this report and other information regarding influenza can be accessed at http://www.cdc.gov/ncidod/diseases/flu/fluvirus.htm.
5,334 citations
TL;DR: In a meta-analysis of 20 cohort studies, the pooled estimates of vaccine efficacy (1-odds ratio) were 56% (95% CI, 39% to 68%) for preventing respiratory illness, 53% (CI, 35% to 66%), for preventing pneumonia, 50%(CI, 28% to 65%), and 68% (i.e., 56% to 76%).
Abstract: . Objective : To quantify the protective efficacy of influenza vaccine in elderly persons. . Data Sources : A MEDLINE search was done using the index terms influenza vaccine, vaccine efficacy, elderly, mortality, hospitalized, and pneumonia. Appropriate references in the initially selected articles were also reviewed. . Study Selection : Only cohort observational studies with mortality assessment were included in the meta-analysis. In addition, 3 recent case-control studies, 2 cost-effectiveness studies, and 1 randomized, double-blind, placebo-controlled trial were reviewed. . Data Extraction : Vaccine and epidemic virus strains, age and sex of patients, severity of illness, patient status, and study design were recorded. Upper respiratory illness, hospitalization, pneumonia, and mortality were used as outcome measures. . Data Synthesis : In a meta-analysis of 20 cohort studies, the pooled estimates of vaccine efficacy (1-odds ratio) were 56% (95% CI, 39% to 68%) for preventing respiratory illness, 53% (CI, 35% to 66%) for preventing pneumonia, 50% (CI, 28% to 65%) for preventing hospitalization, and 68% (CI, 56% to 76%) for preventing death. Vaccine efficacy in the case-control studies ranged from 32% to 45% for preventing hospitalization for pneumonia, from 31% to 65% for preventing hospital deaths from pneumonia and influenza, from 43% to 50% for preventing hospital deaths from all respiratory conditions, and from 27% to 30% for preventing deaths from all causes. The randomized, double-blind, placebo-controlled trial showed a 50% or greater reduction in influenza-related illness. Recent cost-effectiveness studies confirm the efficacy of influenza vaccine in reducing influenza-related morbidity and mortality and show that vaccine provides important cost savings per year per vaccinated person. . Conclusion : Despite the paucity of randomized trials, many studies confirm that influenza vaccine reduces the risks for pneumonia, hospitalization, and death in elderly persons during an influenza epidemic if the vaccine strain is identical or similar to the epidemic strain. Influenza immunization is an indispensable part of the care of persons 65 years of age and older. Annual vaccine administration requires the attention of all physicians and public health organizations.
1,048 citations
Journal Article•
TL;DR: The meta-analysis confirms the findings of several recent studies on the effectiveness of influenza vaccination in elderly persons and should heighten physician awareness and encourage the universal annual use of influenza vaccine in elderly Persons.
Abstract: Objective: To quantify the protective efficacy of influenza vaccine in elderly persons. Data Sources: A MEDLINE search was done using the index terms influenza vaccine, vaccine efficacy, elderly, m...
1,028 citations
"Effectiveness and cost-benefit of i..." refers background in this paper
...Clinical respiratory illness was defined in 2 ways: (1) ILI was defined as feverishness or a measured temperature of at least 37....
[...]
...Studies have repeatedly demonstrated that influenza vaccination of persons aged 65 years or older is also economically beneficial.(1-4,35) It is less certain whether vaccinating healthy working adults younger than 65 years against influenza would result in societal cost savings....
[...]
...THE COST-EFFECTIVENESS OF INactivated influenza vaccination in reducing influenza illness, hospitalization, and death is well established in persons aged 65 years or older, a group that is at increased risk of severe influenza-related complications.(1-5) However, the benefits of annual influenza vaccination of healthy adults younger than 65 years are less clear....
[...]
TL;DR: In the elderly, influenza vaccination may halve the incidence of serological and clinical influenza (in periods of antigenic drift), which is less pronounced for self-reported influenza.
Abstract: Objective. —To determine the efficacy of influenza vaccination in elderly people. Design. —Randomized double-blind placebo-controlled trial. Setting. —Fifteen family practices in the Netherlands during influenza season 1991-1992. Participants. —A total of 1838 subjects aged 60 years or older, not known as belonging to those high-risk groups in which vaccination was previously given. Intervention. —Purified split-virion vaccine containing A/Singapore/6/86(H1N1), A/Beijing/353/89(H3N2), B/Beijing/1/87, and B/Panama/45/90 (n=927) or intramuscular placebo containing physiological saline solution (n=911). Main Outcome Measures. —Patients presenting with influenzalike illness up to 5 months after vaccination; self-reported influenza in postal questionnaires 10 weeks and 5 months after vaccination; serological influenza (fourfold increase of antibody titer between 3 weeks and 5 months after vaccination). Results. —The incidence of serological influenza was 4% in the vaccine group and 9% in the placebo group (relative risk [RR], 0.50; 95% confidence interval [CI], 0.35 to 0.61). The incidences of clinical influenza were 2% and 3%, respectively (RR, 0.53; 95% CI, 0.39 to 0.73). The effect was strongest for the combination of serological and clinical influenza (RR, 0.42; 95% CI, 0.23 to 0.74). The effect was less pronounced for self-reported influenza. Conclusion. —In the elderly, influenza vaccination may halve the incidence of serological and clinical influenza (in periods of antigenic drift). (JAMA. 1994;272:1661-1665)
850 citations
"Effectiveness and cost-benefit of i..." refers background in this paper
...Studies have repeatedly demonstrated that influenza vaccination of persons aged 65 years or older is also economically beneficial.(1-4,35) It is less certain whether vaccinating healthy working adults younger than 65 years against influenza would result in societal cost savings....
[...]
...THE COST-EFFECTIVENESS OF INactivated influenza vaccination in reducing influenza illness, hospitalization, and death is well established in persons aged 65 years or older, a group that is at increased risk of severe influenza-related complications.(1-5) However, the benefits of annual influenza vaccination of healthy adults younger than 65 years are less clear....
[...]
...7°C ($100°F) plus cough or sore throat (CDC ILI surveillance definition)(29); and (2) upper respiratory illness (URI) was defined as sore throat plus cough, feverishness, or a measured temperature of at least 37....
[...]
TL;DR: The results show that although approximately 50% of episodes of the common cold were caused by rhinoviruses, the etiology can vary depending on the epidemiological situation with regard to circulating viruses.
Abstract: Two hundred young adults with common colds were studied during a 10-month period. Virus culture, antigen detection, PCR, and serology with paired samples were used to identify the infection. Viral etiology was established for 138 of the 200 patients (69%). Rhinoviruses were detected in 105 patients, coronavirus OC43 or 229E infection was detected in 17, influenza A or B virus was detected in 12, and single infections with parainfluenza virus, respiratory syncytial virus, adenovirus, and enterovirus were found in 14 patients. Evidence for bacterial infection was found in seven patients. Four patients had a rise in antibodies against Chlamydia pneumoniae, one had a rise in antibodies against Haemophilus influenzae, one had a rise in antibodies against Streptococcus pneumoniae, and one had immunoglobulin M antibodies against Mycoplasma pneumoniae. The results show that although approximately 50% of episodes of the common cold were caused by rhinoviruses, the etiology can vary depending on the epidemiological situation with regard to circulating viruses. Bacterial infections were rare, supporting the concept that the common cold is almost exclusively a viral disease.
720 citations
Additional excerpts
...In our study, as in most studies, only a minority of the respiratory illnesses among adults were due to influenza.(25,37-39) Third, in approximately 1 of every 10 years, there is a poor antigenic match between vaccine strains and the predominant circulating influenza viruses (Nancy J....
[...]