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. 2020 Dec 17;71(10):e665-e671.
doi: 10.1093/cid/ciaa371.

Relative Effectiveness of the Cell-Cultured Quadrivalent Influenza Vaccine Compared to Standard, Egg-derived Quadrivalent Influenza Vaccines in Preventing Influenza-like Illness in 2017-2018

Constantina Boikos  1 , Gregg C Sylvester  2 , John S Sampalis  3 , James A Mansi  1
Affiliations

Relative Effectiveness of the Cell-Cultured Quadrivalent Influenza Vaccine Compared to Standard, Egg-derived Quadrivalent Influenza Vaccines in Preventing Influenza-like Illness in 2017-2018

Constantina Boikos et al. Clin Infect Dis. .

Abstract

Background: Influenza antigens may undergo adaptive mutations during egg-based vaccine production. In the 2017-2018 influenza season, quadrivalent, inactivated cell-derived influenza vaccine (ccIIV4) vaccine was produced using A(H3N2) seed virus propagated exclusively in cell culture, thus lacking egg adaptive changes. This United States study estimated relative vaccine effectiveness (rVE) of ccIIV4 vs egg-derived quadrivalent vaccines (egg-derived IIV4) for that season.

Methods: Vaccination, outcome, and covariate data were ascertained retrospectively from a electronic medical record (EMR) dataset and analyzed. The study cohort included patients ≥ 4 years of age. rVE was estimated against influenza-like illness (ILI) using diagnostic International Classification of Diseases, Ninth or Tenth Revision codes. The adjusted odds ratios used to derive rVE estimates were estimated from multivariable logistic regression models adjusted for age, sex, race/ethnicity, geographic region, and health status.

Results: Overall, 92 187 individuals had a primary care EMR record of ccIIV4 and 1 261 675 had a record of egg-derived IIV4. In the ccIIV4 group, 1705 narrowly defined ILI events occurred, and 25 645 occurred in the standard egg-derived IIV4 group. Crude rVE was 9.2% (95% confidence interval [CI], 4.6%-13.6%). When adjusted for age, sex, health status, comorbidities, and geographic region, the estimated rVE changed to 36.2% (95% CI, 26.1%-44.9%).

Conclusions: ccIIV4, derived from A(H3N2) seed virus propagated exclusively in cell culture, was more effective than egg-derived IIV4 in preventing ILI during the 2017-2018 influenza season. This result suggests that cell-derived influenza vaccines may have greater effectiveness than standard egg-derived vaccines.

Keywords: cell-derived influenza vaccine; influenza vaccine; influenza-like illness; vaccine effectiveness.

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Figures

Figure 1.
Figure 1.
Results from the propensity score (PS)–matched and adjusted models. Main analyses are multivariable logistic regressions including age, sex, race/ethnicity, and geographic region, with age modeled as age (continuous) with interaction terms: age (continuous) × vaccine group. PS sensitivity analyses are conditional logistic regression models on matched pairs (matched by PS for exposure) with logit (PS) included only as covariate in the model (doubly robust adjustment methodology). Abbreviations: CI, confidence interval; PS, propensity score; rVE, relative vaccine effectiveness.
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