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. 2024 Sep 13;14(1):21466.
doi: 10.1038/s41598-024-72081-z.

Elevated body mass index is not significantly associated with reduced influenza vaccine effectiveness

Jennifer P King  1 , Huong Q Nguyen  2 , Erika L Kiniry  3 , C Hallie Phillips  3 , Manjusha Gaglani  4   5 , Emily T Martin  6 , Krissy Moehling Geffel  7 , Mary Patricia Nowalk  7 , Jessie R Chung  8 , Brendan Flannery  8 , Edward A Belongia  2
Affiliations

Elevated body mass index is not significantly associated with reduced influenza vaccine effectiveness

Jennifer P King et al. Sci Rep. .

Abstract

Elevated body mass index (BMI) has been linked to severe influenza illness and impaired vaccine immunogenicity, but the relationship between BMI and clinical vaccine effectiveness (VE) is less well described. This secondary analysis of data from a test-negative study of outpatients with acute respiratory illness assessed BMI and VE against medically attended, PCR-confirmed influenza over seven seasons (2011-12 through 2017-18). Vaccination status was determined from electronic medical records (EMR) and self-report; BMI was estimated from EMR-documented height and weight categorized for adults as obesity (≥ 30 kg/m2), overweight (25-29 kg/m2), or normal and for children based on standardized z-scales. Current season VE by virus type/subtype was estimated separately for adults and children. Pooled VE for all seasons was calculated as 1-adjusted odds ratios from logistic regression with an interaction term for BMI and vaccination. Among 28,089 adults and 12,380 children, BMI category was not significantly associated with VE against outpatient influenza for any type/subtype. Adjusted VE against A/H3N2, A/H1N1pdm09, and B in adults ranged from 16-31, 46-54, and 44-57%, and in children from 29-34, 57-65, and 50-55%, respectively, across the BMI categories. Elevated BMI was not associated with reduced VE against laboratory confirmed, outpatient influenza illness.

Keywords: Body mass index; Influenza; Obesity; Vaccine effectiveness.

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Conflict of interest statement

EAB and HQN receive research support from Seqirus. MPN receives research support from Sanofi. MJG received research support from MedImmune during some of the analyzed seasons and was the Texas Pediatric Society, Texas Chapter of American Academy of Pediatrics, Co-Chair, Infectious Diseases and Immunization Committee (Sep 2016–Aug 2022). ETM receives research support from Merck. JPK, ELK, CHP, KMG, JRC, and BF report no competing interests.

Figures

Fig. 1
Fig. 1
Adjusted vaccine effectiveness against medically attended influenza A/H3N2, A/H1N1pdm09, and B by BMI category in adults and children/adolescents in the US Flu VE Network, 2011–12 through 2017–18. BMI body mass index, OR odds ratio, CI confidence interval, aVE adjusted vaccine effectiveness. *BMI categories: Adults: Normal (18.5 to < 25 kg/m2), Overweight (25 to < 30 kg/m2), Obesity (≥ 30 kg/m2); Children/adolescents: Normal (BMI percent 5 to < 85), Overweight (BMI percent 85 to < 95), Obesity (BMI percent ≥ 95). †Adjusted vaccine effectiveness—calculated as 100*(1—adjusted odds ratio). Adjusted odds ratio of vaccination status—Adjusted for site, season, age (as spline in adults; as category (2– < 9 years, 9–17 years) in children), BMI, and interaction of BMI and vaccination status.
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