A review of the value of quadrivalent influenza vaccines and their potential contribution to influenza control

Abstract

The contribution of influenza B to the seasonal influenza burden varies from year-to-year. Although 2 antigenically distinct influenza B virus lineages have co-circulated since 2001, trivalent influenza vaccines (TIVs) contain antigens from only one influenza B virus. B-mismatch or co-circulation of both B lineages results in increased morbidity and mortality attributable to the B lineage absent from the vaccine. Quadrivalent vaccines (QIVs) contain both influenza B lineages. We reviewed currently licensed QIVs and their value by focusing on the preventable disease burden. Modeling studies support that QIVs are expected to prevent more influenza cases, hospitalisations and deaths than TIVs, although estimates of the case numbers prevented vary according to local specificities. The value of QIVs is demonstrated by their capacity to broaden the immune response and reduce the likelihood of a B-mismatched season. Some health authorities have preferentially recommended QIVs over TIVs in their influenza prevention programmes.

Keywords: influenza; influenza B; mismatch; quadrivalent influenza vaccine.

Figure 1.

The evaluation of influenza viruses and vaccine development. Information from Hannoun et al. and McCullers et al. *Asian influenza pandemic caused by the shifted A/H2N2 strain and Hong Kong influenza pandemic caused by the shifted A/H3N2 strain: both examples of A-strain shift through reassortment (sharing) of genetic material. LAIV = live-attenuated trivalent influenza vaccine; TIV = trivalent influenza vaccine; QIV = quadrivalent influenza vaccine; WHO = World Health Organization.

Figure 2.

Results of the literature search (30 October 2016). Search string: “(Quadrivalent OR tetravalent) (influenza vaccine OR flu vaccine) (cost OR burden OR epidemiology OR death OR mortality OR illness OR hospitalisation OR hospitalization)” No limits applied.