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. 2018 Feb 1;36(6):853-858.
doi: 10.1016/j.vaccine.2017.12.067. Epub 2018 Jan 9.

Impact of seasonal influenza vaccination in the presence of vaccine interference

Eunha Shim  1 , Kenneth J Smith  2 , Mary Patricia Nowalk  3 , Jonathan M Raviotta  3 , Shawn T Brown  4 , Jay DePasse  4 , Richard K Zimmerman  3
Affiliations

Impact of seasonal influenza vaccination in the presence of vaccine interference

Eunha Shim et al. Vaccine. .

Abstract

Background: Annual influenza vaccination is a key to preventing widespread influenza infections. Recent reports of influenza vaccine effectiveness (VE) indicate that vaccination in prior years may reduce VE in the current season, suggesting vaccine interference. The purpose of this study is to evaluate the potential effect of repeat influenza vaccinations in the presence of vaccine interference.

Methods: Using literature-based parameters, an age-structured influenza equation-based transmission model was used to determine the optimal vaccination strategy, while considering the effect of varying levels of interference.

Results: The model shows that, even in the presence of vaccine interference, revaccination reduces the influenza attack rate and provides individual benefits. Specifically, annual vaccination is a favored strategy over vaccination in alternate years, as long as the level of residual protection is less than 58% or vaccine interference effect is minimal. Furthermore, the negative impact of vaccine interference may be offset by increased vaccine coverage levels.

Conclusions: Even in the presence of potential vaccine interference, our work provides a population-level perspective on the potential merits of repeated influenza vaccination. This is because repeat vaccination groups had lower attack rates than groups that omitted the second vaccination unless vaccine interference was at very high, perhaps implausible, levels.

Keywords: Influenza; Vaccination; Vaccine effectiveness; Vaccine interference.

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Conflict of interest statement

Conflict of interest: Richard Zimmerman has active research grants from Sanofi Pasteur, Pfizer Inc., and Merck & Co., Inc. Mary Patricia Nowalk and Jonathan Raviotta have received or currently receive grant funding from Pfizer, Inc. and Merck & Co., Inc. No other financial disclosures were reported by the authors of this paper.

Declaration of interests

Richard Zimmerman has active research grants from Sanofi Pasteur, Pfizer Inc., and Merck & Co., Inc. Mary Patricia Nowalk and Jonathan Raviotta have received or currently receive grant funding from Pfizer, Inc. and Merck & Co., Inc. The other authors have no conflicts to declare.

Figures

Figure 1
Figure 1
The likelihood of clinical influenza disease with various vaccine coverage levels. The probability of clinical influenza disease is calculated, averaged over all ages, at increasing levels of vaccine coverage.
Figure 2
Figure 2
Two-way sensitivity analysis–annual vaccination vs. vaccination in alternate years. For two-way sensitivity analysis, we simultaneously varied the level of vaccine interference (VI) and εT,k, i.e., the level of residual protection among individuals vaccinated in the prior season only. The likelihoods of influenza among those vaccinated in the prior season only and those vaccinated in both prior and current seasons were calculated and compared over a range of parameter values of VI and εT,k. The area where the likelihood of influenza among annual vaccinators (Wk) is lower than that among individuals who are vaccinated in alternate years (Tk) is depicted in yellow. The area where vaccination in alternate years results in lower likelihood of influenza than among annual vaccinators is depicted in blue.
Figure 3
Figure 3
The likelihood of influenza disease. To examine the benefits of vaccination at an individual level, the likelihood of influenza disease was compared between vaccinees and non-vaccinees a) among individuals receiving influenza vaccine in the prior year; and b) among individuals who skipped influenza vaccine in the prior year.
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